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THE  CARE  AND  FEEDING 
OF  CHILDREN 

A   CATECHISM    FOR   THE    USE    OF   MOTHERS 
AND    CHILDREN'S    NURSES 


BY 

L.   EMMETT   HOLT,  M.D.,  LL.D. 

PROFESSOR   OF   DISEASES   OF  CHILDREN   IN    THE   COLLEGE    OF   PHYSICIANS 

AND   SURGEONS    (COLUMBIA   UNIVERSITY) 

ATTENDING   PHYSICIAN   TO   THE    BABIES*    HOSPITAL   AND  THE 

FOUNDLING   HOSPITAL,   NEW  YORK 


iFiftb  Edition,  C^e^i^eb  anb  ^Pnlargeti 


NEW  YORr==*3^ffinCDNDON 

D.   APPLETON   AND    COMPANY 

1910 


"*%,., 


% 


OOPYMGHT,  1894,  1897,  1903,  1906,  1909,  by 
D.   APPLETON  AND  COMPANY 


Printed  in  the  United   States  of  America 


TO 
THE  YOUNG  MOTHEKS   OF  AMERICA, 

TOWARD  THE  SOLUTION  OF  WHOSE  PROBLEMS 
THESE  PAGES  HAVE  BEEN  DEVOTED, 

THIS  WORK 

IS     RESPECTFULLY     DEDICATED 
BY  THE   AUTHOR. 


214920 


>'     OF   THE 

UNIVERSITY 

Of 


PEEFACE    TO    THE    FIETH   EDITIO:^' 


The  constant  use  of  the  Catechism  as  a  manual 
for  nursery  maids  has  shown  the  need  of  fuller  treat- 
ment of  several  subjects  than  was  given  in  the  earlier 
editions.  An  attempt  has  been  made  to  meet  the 
needs  of  mothers  and  nurses  outside  of  institutions 
who  have  made  the  book  a  nursery  guide,  especially 
in  matters  relating  to  older  children. 

The  chapters  upon  infant  feeding  have  been 
largely  rewritten  and,  it  is  hoped,  simplified  for  the 
average  reader.  Some  further  details  relating  to  in- 
fants whose  nutrition  is  difficult  have  been  intro- 
duced, although  the  scope  of  the  book  makes  this 
part  necessarily  brief. 

The  author's  aim  has  been  not  to  alarm  the  mother 
by  acquainting  her  with  all  the  possible  diseases  and 
accidents  which  may  befall  her  child,  but  to  open 
her  eyes  to  matters  which  are  her  direct  and  chief 
concern. 

It  is,  therefore,  the  needs  of  the  well  child,  not 

7 


8    THE  CARE  AND  FEEDING  OF  CHILDREN 

the  sick  one,  which  have  been  considered.  The  well 
child  must,  in  most  cases,  be  left  to  the  care  of  the 
mother  or  nurse  for  whose  guidance  and  assistance 
these  pages  are  intended.  For  directions  in  matters 
of  illness,  however,  no  mother  or  nurse  should  de- 
pend upon  any  manual,  but  upon  the  advice  of  a 
physician. 

It  is  hoped  that  the  mothers  and  nurses  who  have 
found  the  earlier  editions  of  the  Catechism  helpful 
in  the  solution  of  some  of  their  nursery  problems 
will  find  even  greater  assistance  from  the  present 
volume. 

New  York,  1909. 


CONTENTS 


I 

THE  CAEE  OF  CHILDEEN 

PAGB 

Bathing ,        ,        ,  15 

Genital  organs 16 

Eyes  . 17 

Mouth 18 

Skin •  1^ 

Clothing 21 

Napkins 24 

Nursery 25 

Airing 27 

Weight,  growth,  and  development  ......  30 

Dentition 36 


n 

INFANT  FEEDING 

Nursing 42 

Weaning  from  the  breast 49 

Weaning  from  the  bottle 52 

Artificial  feeding 54 

Selection  and  care  of  milk  used  for  infant  feeding ...  54 


10        THE  CARE  AND  FEEDING  OF  CHILDREN 


PAGE 

Modification  of  cow's  milk 59 

Top  milk,  63 ;  cream,  66. 

Food  for  healthy  infants 66 

Formulas  from  7-per-cent  milk,  68;  formulas  from 

whole  milk,  73. 

<jeneral  rules  for  guidance  in  feeding 76 

How  to  begin,  77:  increasing  the  food,  77;  reducing 

the  food,  81. 
Addition  of  other  foods  to  milk       .        .        .        .        .        .83 

Use   of    beef  juice,- 82;    white    of   egg,   83;   orange 

juice,  83. 

Overfeeding 84 

Loss  of  appetite 86 

Changes  in  food  required  by  special  symptoms       ...  87 

Vomiting,  88 ;  colic,  90 ;  constipation,  90 ;  hot  weather, 

92 ;  use  of  condensed  milk,  93 ;  acute  illness,  95 ;  diar- 
rhoea, 96. 

Common  mistakes  in  infant  feeding 97 

Preparation  of  milk  at  home 99 

Directions  for  feeding 102 

Intervals  of  feeding .  104 

Schedule  of  quantities  and  intervals  for  first  year  .        .        .  105 

Regularity  in  feeding 106 

Sterilized  milk 107 

Pasteurized  milk .  110 

Modified  milk  from  the  milk  laboratories       ....  Ill 

Peptonized  milk 112 

Feeding  during  the  second  year 115 

Schedule  for  twelfth  to  fifteenth  month  .        .        .        .        .116 
Schedule  for  fifteenth  to  eighteenth  month     .        .        ,        .118 

Schedule  for  eighteenth  to  twenty-fourth  month    ,        ,        ,  119 

Feeding  during  the  third  year 120 


CONTENTS  11 


III 
THE  DIET  OF  OLDER  CHILDREN 

PAOK 

Milk  and  cream 125 

Eggs 127 

Meats  and  fish  .• 128 

Vegetables 129 

Cereals 131 

Broths  and  soups 132 

Bread,  crackers,  and  cakes 133 

Desserts 133 

Fruits 135 

Indigestion  in  older  children 137 

Acute  indigestion,  138 ;  chronic  indigestion,  139. 

General  rules  to  be  observed  in  feeding 141 

Food  formulas 144 

Beef  juice,  144 ;  mutton  broth,  145 ;  chicken,  veal,  and 
beef  broths,  146;  scraped  beef  or  meat  pulp,  146; 
junket,  curds,  and  whey,  146 ;  barley  water,  147 ;  bar- 
ley jelly,  147;  rice,  wheat,  oat  water,  147;  oat,  wheat, 
rice  jelly,  148 ;  imperial  granum,  148 ;  albumin  water, 
148 ;  lime-water,  148 ;  dried  bread,  149 ;  coddled  egg, 
149. 

IV 

MISCELLANEOUS 

Bowels 153 

Sleep 155 

Causes  of  disturbed  sleep  . 157 

Exercise 159 

Cry 160 

Lifting  children- 162 

Temperature 163 

Nervousness       .        ,        .' 165 


12    THE  CARE  AND  FEEDING  OF  CHILDREN 

PAGE 

Playing  with  babies 165 

Toys 166 

Kissing 168 

Convulsions 168 

Foreign  bodies  swallowed ,169 

Foreign  bodies  in  the  ear 170 

Foreign  bodies  in  the  nose 170 

Colic 170 

Earache 171 

Croup 172 

Contagious  diseases 173 

Measles,  173;  German  measles,  174;  scarlet  fever,  175; 

whooping  cough,  175;  chicken  pox,  175;  diphtheria, 

175 ;  mumps,  176. 

Treatment  for  commencing  illness 177 

Nursery  training  to  help  the  doctor 178 

Scurvy ,     .        .        .        .178 

Constipation (__ ....  180 

Diarrhoea 182 

Bad  habits 183 

Vaccination       ..........  187 

Weight  charts 189,190 

Index 191 


PAET  I 
THE    CAKE    OF    CHILDEEN" 


THE   CAKE  AND  FEEDING  OF 
CHILDREN 


I 

THE  CARE  OF  CHILDEEN 

BATHING 

At  what  age  may  a  child  he  given  a  full  tub  hath? 
Usually  when  ten  days  old;   it  should  not  be 
given  before  the  cord  has  come  off. 

How  should  the  hath  he  given? 

It  should  not  be  given  sooner  than  one  hour  after 
feeding.  The  room  should  be  warm;  if  possible 
there  should  be  an  open  fire.  The  head  and  face 
should  first  be  washed  and  dried;  then  the  body 
should  be  soaped  and  the  infant  placed  in  the  tub 
with  its  body  well  supported  by  the  hand  of  the 
nurse.  The  bath  should  be  given  quickly,  and  the 
body  dried  rapidly  with  a  soft  towel,  but  with  very 
little  rubbing. 

At  what  temperature  should  the  hath  he  given? 
For  the  first  few  weeks  at  100°  F. ;  later,  dur- 
ing early  infancy,    at   98°   F. ;    after   six   months, 

15 


16        THE  CARE  AND  FEEDING  OF  CHILDREN 

at   95°  F. ;   during  the  second  year,  from  85°  to 
90°  F. 

With  what  should  the  hath  he  given? 

Soft  sponges  are  useful  for  bathing  the  body, 
limbs  and  scalp.  There  should  be  a  separate  wash- 
cloth for  the  face  and  another  for  the  buttocks. 

What  are  the  objections  to  hath  sponges? 

When  used  frequently,  they  become  very  dirty 
and  are  liable  to  cause  infection  of  the  eyes,  mouth 
or  genital  organs. 

Under  what  circumstances  should  the  daily  tub 
hath  he  omitted? 

In  the  case  of  very  feeble  or  delicate  infants  on 
account  of  the  exposure  and  fatigue,  and  in  all  forms 
of  acute  illness  except  by  direction  of  the  physician. 
In  eczema  and  many  other  forms  of  skin  disease 
much  harm  is  often  done  by  bathing  with  soap  and 
water,  or  even  with  water  alone. 

GENITAL    OEGAIfS 

How  should  the  genital  organs  of  a  female  child 
he  cleansed? 

Best  with  fresh  absorbent  cotton  and  tepid  water, 
or  a  solution  of  boric  acid,  two  teaspoonfuls  to  the 
pint.  This  should  be  done  carefully  at  least  once  a 
day.     If  any  discharge  is  present,  the  boric-acid  so- 


EYES  17 

lution  should  invariably  be  used  twice  a  day.  Great 
care  is  necessary  at  all  times  to  prevent  infection 
which  often  arises  from  soiled  napkins. 

How  should  the  genital  organs  of  a  male  child 
he  cleansed? 

In  infancy  and  early  childhood  the  foreskin 
should  be  pushed  back  at  least  twice  a  week  while 
the  child  is  in  his  bath,  and  the  parts  thus  exposed 
washed  gently  with  absorbent  cotton  and  water. 

If  the  foreskin  is  tightly  adherent  and  cannot 
readily  be  pushed  back,  the  physician's  attention 
should  be  called  to  it.  The  nurse  or  mother  should 
not  attempt  forcible  stretching. 

When  is  circumcision  advisable? 

Usually,  when  the  foreskin  is  very  long  and  so 
tight  that  it  cannot  be  pushed  back  without  force; 
always,  when  this  condition  is  accompanied  by  evi- 
dences of  local  irritation  or  difficulty  in  passing 
water. 

EYES 

How  should  the  eyes  of  a  little  hahy  he  cleansed? 

With  a  piece  of  soft  linen  or  absorbent  cotton 
and  a  lukewarm  solution  of  salt  or  boric  acid, — one 
half  of  an  even  teaspoonful  to  one  pint  of  water. 


18        THE  CARE  AND  FEEDING  OF  CHILDREN 

//  pus  appears  in  the  eyes,  what  should  he 
done? 

They  should  be  cleansed  every  hour  with  a  solu- 
tion of  boric  acid  (ten  grains  to  one  ounce  of  water). 
If  the  lids  stick  together,  a  little  vaseline  from  a  tube 
should  be  rubbed  upon  them  at  night.  If  the  trouble 
is  slight,  this  treatment  will  control  it ;  if  it  is  severe, 
a  physician  should  be  called  immediately,  as  delay 
may  result  in  loss  of  eyesight. 

MOUTH 

How  is  an  infant's  mouth  to  he  cleansed? 

An  excellent  method  is  by  the  use  of  a  swab  made 
by  twisting  a  bit  of  absorbent  cotton  upon  a  wooden 
toothpick.  With  this  the  folds  between  the  gums  and 
lips  and  cheeks  may  be  gently  and  carefully  cleansed 
twice  a  day  unless  the  mouth  is  sore.  It  is  not  neces- 
sary after  every  feeding.  The  finger  of  the  nurse, 
often  employed,  is  too  large  and  liable  to  injure  the 
delicate  mucous  membrane. 

What  is  sprue? 

It  appears  on  the  lips  and  inside  the  cheeks  like 
little  white  threads  or  flakes.  It  is  also  called  thrush. 
In  bad  cases  it  may  cover  the  tongue  and  the  whole 
of  the  inside  of  the  mouth. 


SKIN  1& 

How  should  a  mouth  he  cleansed  when  there  is 
sprue ? 

It  should  be  washed  carefully  after  every  feeding- 
or  nursing  with  a  solution  of  borax  or  bicarbonate  of 
soda  (baking  soda),  one  even  teaspoonful  to  three 
ounces  of  water,  and  four  times  a  day  the  boric-acid 
solution  mentioned  should  be  used. 

sKiiq" 

How  should  the  infant's  shin  he  cared  for  ttf 
prevent  chafing? 

First,  not  too  much  nor  too  strong  soap  should  be 
used ;  secondly,  careful  rinsing  of  the  body ;  thirdly,, 
not  too  vigorous  rubbing,  either  during  or  after  the 
bath ;  fourthly,  the  use  of  dusting  powder  in  all  the 
folds  of  the  skin, — under  the  arms,  behind  the  ears,, 
about  the  neck,  in  the  groin,  etc.  This  is  of  the 
utmost  importance  in  very  fat  infants. 

If  the  shin  is  very  sensitive  and  chafing  easily 
produced,  what  should  he  done? 

No  soap  should  be  used,  but  bran  or  salt  baths 
given  instead. 

How  should  a  hran  hath  he  prepared? 
One  pint  of  wheat  bran  should  b<e  placed  in  a  bag 
of  coarse  muslin  or  cheese-cloth,  and  this  put  in  the 


20    THE  CARE  AND  FEEDING  OF  CHILDREN 

bath  water.  It  should  then  be  squeezed  for  five  min- 
utes, until  the  water  resembles  a  thin  porridge. 

How  should  a  salt  hath  he  prepared? 

A  teacupful  of  common  salt  or  sea  salt  should  be 
used  to  each  two  gallons  of  water. 

How  should  the  huttocks  he  cared  for? 

This  is  the  most  common  place  for  chafing,  as  the 
parts  are  so  frequently  wet  and  soiled;  hence  the 
utmost  pains  should  be  taken  that  all  napkins  be  re- 
moved as  soon  as  they  are  wet  or  soiled,  and  the  parts 
kept  scrupulously  clean. 

If  the  parts  have  hecome  chafed,  what  should  he 
done? 

Only  bran  and  salt  baths  should  be  used,  and  in 
very  severe  cases  even  these  may  have  to  be  omitted 
for  a  day  or  two.  The  parts  may  be  cleansed  with 
sweet  oil  and  a  little  absorbent  cotton,  and  the  skin 
kept  covered  with  a  dusting  powder  composed  of 
starch  two  parts,  boric  acid  one  part. 

What  is  prichly  heat,  and  how  is  it  produced? 

It  consists  of  fine  red  pimples,  and  is  caused  by 
excessive  perspiration  and  the  irritation  of  flannel 
underclothing. 

How  should  it  he  treated? 

Muslin  or  linen  should  be  put  next  to  the  skin; 
the  entire  body  should  be  sponged  frequently  with 


CLOTHING  21 


equal  parts  of  vinegar  and  water,  and  plenty  of  the 
starch  and  boric-acid  powder  mentioned  should  be 
used. 

CLOTHIITG 

What  are  the  most  essential  things  in  the  clothing 
of  infants? 

That  the  chest  shall  be  covered  with  soft  flannel, 
the  limbs  well  protected  but  not  confined,  and  the 
abdomen  supported  by  a  broad  flannel  band,  which 
should  be  snug  but  not  too  tight.  It  is  important 
that  the  clothing  should  fit  the  body.  If  it  is  too 
tight  it  interferes  with  the  free  movements  of  the 
chest  in  breathing,  and  by  pressing  upon  the  stomach 
sometimes  causes  the  infant  to  vomit  soon  after  swal- 
lowing its  food.  If  the  clothing  is  too  loose  it  is 
soon  thrown  into  deep  folds  or  bunches,  which  cause 
much  discomfort,  l^o  pins  should  be  used,  but,  in- 
stead, all  bands  about  the  body  should  be  basted. 
The  petticoats  should  be  supported  by  shoulder 
straps. 

How  should  the  infant  he  held  during  dressing 
and  undressing? 

!N"othing  is  more  awkward  than  to  attempt  to 
dress  a  young  baby  in  a  sitting  posture.  It  should 
lie  upon  the  nurse's  lap  until  quite  old  enough  to 


22         THE  CARE  AND  FEEDING  OF  CHILDREN 

sit  alone,  the  clothing  being  drawn  over  the  child's 
feet,  not  slipped  over  the  head. 

Of  what  use  is  the  hand? 

It  protects  the  abdomen,  but  its  most  important 
use  is  to  support  the  abdominal  walls  in  very  young 
infants,  and  in  this  way  to  prevent  the  occurrence  of 
rupture. 

Hoiv  long  is  this  hand  required? 

The  snug  flannel  band,  not  usually  more  than 
four  months.  In  healthy  infants  this  may  then  be 
replaced  by  the  knitted  band,  which  may  be  worn 
up  to  eighteen  months.  The  band  is  an  important 
article  of  dress  in  the  case  of  thin  infants  whose  ab- 
dominal organs  are  not  sufficiently  protected  by  fat. 
With  such,  or  with  those  prone  to  diarrhoea,  it  is 
often  advisable  to  continue  the  band  until  the  third 
year. 

What  changes  are  to  he  made  in  the  clothing  of 
infants  in  the  summer? 

Only  the  thinnest  gauze  flannel  undershirts 
should  be  worn,  and  changes  in  temperature  should 
be  met  by  changes  in  the  outer  garments.  The  great- 
est care  should  be  taken  that  children  are  not  kept 
too  hot  in  the  middle  of  the  day,  while  extra  wraps 
should  be  used  morning  and  evening,  especially  at 
the  seashore  or  in  the  mountains. 


CLOTHING 


Should  older  children  he  allowed  to  go  with  their 
legs  hare? 

If  strong  and  well  there  is  no  objection  to  this  in 
very  hot  weather.  In  cold  weather,  however,  it  is 
doubtful  if  any  children  are  benefited  by  it,  particu- 
larly in  a  changeable  climate  like  that  of  ISTew  York. 
Many  delicate  children  are  certainly  injured  by  such 
attempts  at  hardening. 

What  sort  of  underclothing  should  he  worn  dur- 
ing cold  weather? 

ITever  the  heaviest  weight,  even  in  winter.  Four 
grades  are  usually  sold,  the  next  to  the  heaviest  being 
thick  enough  for  any  child. 

Do  little  children  require  as  heavy  flannels  as 
older  people? 

'Not  as  a  rule.  They  usually  live  in  a  warm 
nursery ;  their  circulation  is  active ;  and  they  always 
perspire  easily  during  their  play.  When  they  go  out 
of  doors,  the  addition  of  coats  and  leggings  renders 
thick  flannels  unnecessary. 

Are  not  many  little  children  clothed  too  thinly 
for  the  ordinary  house? 

Very  few.  The  almost  invariable  mistake  made 
in  city  homes  is  that  of  excessive  clothing  and  too 
warm  rooms.  These  two  things  are  among  the  most 
frequent  reasons  for  their  taking  cold  so  easily. 


34         THE  CAEE  AN1>  FEEDING  OP  CHILDREN 


NAPKINS 

How  should  naphins  he  taken  care  of? 

They  should  be  immediately  removed  from  the 
nursery  when  soiled  or  wet.  Soiled  napkins  should 
be  kept  in  a  receptacle  with  a  tight  cover,  and  washed 
as  soon  as  possible. 

Should  naphins  which  have  been  only  wet  he 
used  a  second  time  without  washing? 

It  is  no  doubt  better  to  use  only  fresh  napkins, 
but  there  is  no  serious  objection  to  using  them  twice 
unless  there  is  chafing  of  the  skin.  Clean  napkins, 
changed  as  soon  as  wet  or  soiled,  are  of  much  im- 
portance in  keeping  the  skin  healthy. 

What  are  the  important  things  to  he  ohserved  in 
washing  napkins? 

Soiled  napkins  should  not  be  allowed  to  dry,  but 
should  receive  a  rough  washing  at  once ;  they  should 
then  be  kept  in  soak  in  plain  water  until  a  conven- 
ient time  for  washing, — at  least  once  every  day, — 
when  they  should  be  washed  in  hot  suds  and  boiled 
at  least  fifteen  minutes.  Afterward  they  should  be 
very  thoroughly  rinsed  or  they  may  irritate  the  skin, 
and  ironed  without  starch  or  blueing.  They  should 
never  be  used  when  damp. 


NURSERY  25 


NURSERY 

What  are  the  essentials  in  a  good  nursery? 

The  furnishings  should  be  very  simple,  and  un- 
necessary hangings  and  upholstered  furniture  should 
be  excluded.  As  large  a  room  as  possible  should  be 
selected — one  that  is  well  ventilated,  and  always  one 
in  which  the  sun  shines  at  some  part  of  the  day,  as 
it  should  be  remembered  that  an  average  child  spends 
here  at  least  three  fourths  of  its  time  during  the  first 
year.  The  nursery  should  have  dark  shades  at  the 
windows,  but  no  extra  hangings  or  curtains;  about 
the  baby's  crib  nothing  but  what  can  be  washed 
should  be  allowed.  The  air  should  be  kept  as  fresh 
and  as  pure  as  possible.  There  should  be  no  plumb- 
ing, no  drying  of  napkins  or  clothes,  no  cooking  of 
food,  and  no  gas  burning  at  night.  A  small  wax 
night-light  answers  every  purpose. 

How  should  a  nursery  he  heated? 

Best  by  an  open  fire ;  next  to  this  by  a  Franklin 
stove.  The  ordinary  hot-air  furnace  of  cities  has 
many  objections,  but  it  is  not  so  bad  as  steam  heat 
from  a  radiator  in  the  room.  A  gas  stove  is  even 
worse  than  this,  and  should  never  be  used,  except, 
perhaps,  for  a  few  minutes  during  the  morning 
bath. 


26    THE  CARE  AND  FEEDING  OF  CHILDREN 

At  tvJiat  temperature  should  a  nursery  he  kept 
during  the  day? 

Best,  66°  to  68°  F.,  measured  by  a  thermometer 
banging  three  feet  from  the  floor,  l^ever  should  the 
temperature  be  allowed  to  go  above  70°  F. 

At  what  temperature  during  the  night? 

During  the  first  two  or  three  months,  not  below 
65°  F.  After  three  months  the  temperature  may  go 
as  low  as  55°  F.  After  the  first  year  it  may  be  50° 
or  even  45°  F. 

At  what  age  may  the  window  he  left  open  at 
night? 

Usually  after  the  third  month,  except  when  the 
outside  temperature  is  below  freezing  point. 

How  often  should  the  nursery  he  aired? 

At  least  twice  a  day — in  the  morning  after  the 
child's  bath,  and  , again  in  the  evening  before  the 
child  is  put  to  bed  for  the  night.  This  should  be 
done  thoroughly,  and  the  child  should  be  removed 
meanwhile  to  another  apartment.  It  is  well  to  air 
the  nursery  whenever  the  child  is  out  of  the  room. 

What  symptoms  are  seen  in  a  child  who  is  Tcept 
in  too  hot  a  room? 

It  becomes  pale,  loses  appetite,  shows  symptoms 
of  indigestion,  occasionally  vomits,  stops  gaining  in 


^^j^.^«hV&*^        AIRINa  27 

weight,  perspires  very  mucli,  and  takes  cold  easily 
because  of  this  and  also  because  of  the  great  differ- 
ence between  the  indoor  and  outdoor  temperatures. 
Its  condition  may  be  such  as  to  lead  one  to  suspect 
very  serious  illness. 

AIKIITG 

How  early  may  airing  indoors  he  commenced  and 
how  long  may  it  he  continued  f 

Airing  in  the  room  may  be  begun,  even  in  cold 
weather,  when  the  child  is  one  month  old,  at  first  for 
only  fifteen  minutes  at  a  time.  This  period  may  be 
gradually  lengthened  by  ten  or  fifteen  minutes  each 
day  until  it  is  four  or  five  hours.  This  airing  may 
be  continued  in  almost  all  kinds  of  weather. 

Is  there  not  great  danger  of  a  young  hahy's  talc- 
ing  cold  when  aired  in  this  manner? 

Not  if  the  period  is  at  first  short  and  the  baby 
accustomed  to  it  gradually.  Instead  of  rendering  the 
child  liable  to  take  cold,  it  is  the  best  means  of  pre- 
venting colds. 

How  should  such  an  airing  he  given? 

The  child  should  be  dressed  with  bonnet  and  light 
coat  as  if  for  the  street  and  placed  in  its  crib  or  car- 
riage which  should  stand  a  few  feet  from  the  win- 
dow.    All  the  windows  are  then  thrown  wide  open, 


28         THE  CARE  AND  FEEDING  OP  CHILDREN 

but  the  doors  closed  to  prevent  draughts.     Screens 
are  unnecessary. 

At  what  age  may  a  child  go  out  of  doors? 

In  summer,  when  one  week  old ;  in  spring  and 
fall,  usually  at  about  one  month;  in  winter,  when 
about  three  months  old,  on  pleasant  days,  being  kept 
in  the  sun  and  out  of  the  wind. 

What  are  the  best  hours  for  airing  out  of  doors? 

In  summer  and  early  autumn  a  child  may  be  out 
almost  any  time  between  seven  in  the  morning  and 
sunset;  in  winter  and  early  spring,  a  young  child 
only  between  10  or  11  a.  m.  and  3  p.  m.,  although 
this  depends  somewhat  upon  the  climate.  In  Kew 
York  and  along  the  Atlantic  coast  the  early  morn- 
ings are  apt  to  be  damp  and  the  afternoons  raw  and 
cloudy. 

On  what  hind  of  days  should  a  hahy  not  go  out? 

In  sharp  winds,  when  the  ground  is  covered  with 
melting  snow,  and  when  it  is  extremely  cold.  A  child 
under  four  months  old  should  not  usually  go  out  if 
the  thermometer  is  below  freezing  point;  nor  one 
under  eight  months  old  if  it  is  below  20°  F. 

What  are  the  most  important  things  to  he  attended 
to  when  the  child  is  out  in  its  carriage  ? 

To  see  that  the  wind  never  blows  in  its  face,  that 
its  feet  are  properly  covered  and  warm,  and  that  the 


AIRING 


sun  is  never  allowed  to  shine  directly  into  its  eyes 
when  the  child  is  either  asleep  or  awake. 

Of  what  advantage  to  the  child  is  going  out? 

Fresh  air  is  required  to  renew  and  purify  the 
blood,  and  this  is  just  as  necessary  for  health  and 
growth  as  proper  food. 

What  are  the  effects  produced  in  infants  hy  fresh 
airf 

The  appetite  is  improved,  the  digestion  is  better, 
the  cheeks  become  red,  and  all  signs  of  health  are 
seen. 

7s  there  any  advantage  in  having  a  child  take 
its  airing  during  the  first  five  or  six  months  in  the 
nurse's  arms? 

!N^one  whatever.  A  child  can  be  made  much  more 
comfortable  in  a  baby  carriage,  and  can  be  equally 
well  protected  against  exposure  by  blankets  and  the 
carriage  umbrella. 

What  are  the  objections  to  an  infant's  sleeping 
out  of  doors? 

There  are  no  real  objections.  It  is  not  true  that 
infants  take  cold  more  easily  when  asleep  than  awake, 
while  it  is  almost  invariably  the  case  that  those  who 
sleep  out  of  doors  are  stronger  children  and  less  prone 
to  take  cold  than  others. 


30         THE  CARE  AND  FEEDING  OF  CHILDREN 

What  can  he  done  for  children  who  take  cold 
upon  the  slightest  provocation? 

They  should  be  kept  in  cool  rooms,  especially 
when  asleep.  They  should  not  wear  such  heavy 
clothing  that  they  are  in  a  perspiration  much  of 
the  time.  Every  morning  the  body,  particularly  the 
chest  and  back,  should  be  sponged  with  cold  water 
(50°  to  60°  F.). 

Eoiv  should  this  cold  sponge  hath  he  given? 

The  child  should  stand  in  a  tub  containing  a 
little  warm  water,  and  a  large  bath  sponge  filled  with 
cold  water  should  be  squeezed  two  or  three  times 
over  the  body.  This  should  be  followed  by  a  vigor- 
ous rubbing  with  a  towel  until  the  skin  is  quite  red. 
This  may  be  used  at  three  years,  and  often  at  two 
years.  For  infants  a  little  higher  temperature  (65^ 
to  70°)  may  be  used. 

WEIGHT,    GROWTH,    AND    DEVELOPMENT 

Of  what  importance  is  the  weight  of  th^  child? 

!N'othing  else  tells  so  accurately  how  well  it  is 
thriving. 

During  the  first  year  a  record  of  the  weight  is 
almost  indispensable;  throughout  childhood  it  is  of 
much  interest  and  is  the  best  guide  to  the  physical 


WEIGHT,  GROWTH,  AND  DEVELOPMENT  31 

condition.     It  will  well  repay  any  mother  or  nurse 
to  keep  such  a  record. 

,  How  frequently  should  a  child  he  weighed'^ 
Every  week  during  the  first  six  months,  and  at 
least  once  in  two  weeks  during  the  last  six  months 
of  the  first  year.     During  the  second  year  a  child 
should  be  weighed  at  least  once  a  month. 

How  rapidly  should  an  infant  gain  in  weight 
during  the  first  year? 

There  is  usually  a  loss  during  the  first  week  of 
from  four  to  eight  ounces ;  after  this  a  healthy  child 
should  gain  from  four  to  eight  ounces  a  week  up  to 
about  the  sixth  month.  From  six  to  twelve  months 
the  gain  is  less,  usually  from  two  to  four  ounces  a 
week. 

Is  it  to  he  expected  that  hottle-fed  infants  will 
gain  as  rapidly  as  those  who  are  nursed? 

They  seldom  do  so  during  the  first  month ;  after 
that  time  under  favourable  circumstances  the  gain 
is  usually  quite  as  regular,  and  during  the  latter 
half  of  the  first  year  it  is  likely  to  be  more  con- 
tinuous than  in  a  nursing  infant,  because  the  latter 
usually  loses  weight  at  the  time  of  weaning. 

Why  do  they  not  gain  so  rapidly  at  first? 
It  takes  a  few  weeks  for  the  stomach  to  become 
accustomed  to  cow's  milk,  and  until  this  is  accom- 


32    THE  CAKE  AND  FEEDING  OF  CHILDREN 

plished  it  is  necessary  to  make  the  milk  very  weak 
or  the  child's  digestion  will  be  upset. 

For  a  child  of  average  iveight  at  hirth  (seven 
to  seven  and  a  half  pounds)  what  should  he  the 
weight  at  the  different  periods  during  the  first 
year? 

At  three  months  it  should  be  twelve  to  thirteen 
pounds ;  at  six  months,  fifteen  to  sixteen  pounds ;  at 
nine  months,  seventeen  to  eighteen  pounds;  at  one 
year,  twenty  to  twenty-two  pounds.  At  Rye  months 
a  healthy  child  will  usually  double  its  weight,  and 
at  twelve  months  it  will  nearly  treble  its  weight. 

Do  all  healthy  infants  gain  steadily  in  weight 
during  the  first  year? 

As  a  rule  they  do;  yet  it  is  seldom  the  case  that 
one  gains  every  week  for  the  entire  year.  With  most 
infants  there  are  from  time  to  time  periods  of  a  few 
weeks  in  which  no  gain  is  made.  These  are  more 
often  seen  from  the  seventh  to  the  tenth  month  and 
frequently  occur  when  the  child  is  cutting  teeth, 
sometimes  during  very  hot  weather. 

Is  it  true  that  every  infant  who  gains  rapidly  in 
weight  is  thriving  normally? 

!N'ot  invariably.  Some  who  are  fed  upon  pre- 
pared infant  foods  increase  rapidly  in  weight  but 


WEIGHT,  GROWTH,  AND  DEVELOPMENT  33 

not  in  strength,  nor  in  their  development  in  other 
respects. 

Is  the  weight  of  as  much  value  in  the  second  year 
as  a  guide  to  the  child's  condition? 

After  the  first  year,  the  gain  in  weight  is  seldom 
continuous;  there  are  many  interruptions,  some  de- 
pend on  season,  and  others  often  occur  without  ap- 
parent cause. 

At  what  age  should  the  fontanel  close? 

The  average  is  about  eighteen  months.  It  seldom 
closes  earlier  than  fourteen  months,  and  it  should 
not  be  open  at  two  years. 

At  what  age  should  a  child  hold  up  its  head? 

As  a  rule  during  the  fourth  month,  and  often 
during  the  third  month,  the  head  can  be  held  erect 
when  the  body  is  supported. 

When  does  an  infant  first  laugh  aloud? 
Usually  from  the  third  to  the  fifth  month. 

When  does  it  begin  to  reach  for  toys  and  handle 
them? 

Usually  from  the  fifth  to  the  seventh  month. 

At  what  age  should  a  child  he  able  to  sit  and 
to  stand  alone? 

At  seven  or  eight  months  a  healthy  child  is  usu- 


34         THE  CARE  AND  FEEDING  OP  CHILDREN 

ally  able  to  sit  erect  and  support  the  body.  During 
the  ninth  and  tenth  months  are  usually  seen  the  first 
attempts  to  bear  the  weight  upon  the  feet,  and  at 
eleven  or  twelve  months  most  children  can  stand  with 
assistance. 

When  should  a  child  walk  alone? 

The  first  attempts  are  generally  seen  in  the 
twelfth  or  thirteenth  month.  At  fifteen  or  sixteen 
months  the  average  child  is  able  to  run  alone. 

What  conditions  'postpone  these  events? 

Prematurity,  a  very  delicate  constitution,  any 
severe  or  prolonged  illness,  and  especially  chronic 
disturbances  of  digestion  making  feeding  difficult. 
A  common  cause  of  late  sitting,  standing,  or  walk- 
ing is  rickets. 

Should  a  child  he  urged  to  walk? 

^Never;  he  is  usually  quite  willing  to  do  so  as 
soon  as  his  muscles  and  bones  are  strong  enough. 
]^one  of  the  contrivances  for  teaching  children  to 
walk  are  to  be  advised. 

When  do  children  begin  to  talk? 
Generally  at  one  year  a  child  can  say  "  papa  " 
and  "  mamma  '^  or  other  single  words.     At  the  end 
of  the  second  year  the  average  child  is  able  to  put 
words  together  in  short  sentences. 


WEIGHT,   GROWTH,  AND   DEVELOPMENT  35 

//  at  two  years  the  child  makes  no  attempt  to 
speak,  what  should  he  suspected? 

Either  that  the  child  is  a  deaf-mute  or  that  it  is 
mentally  deficient,  although  this  is  occasionally  seen 
in  children  who  are  only  very  backward. 

Table  showing  the  Average  Weight,  Height,  and   Cir- 
cumference of  Head  and  Chest  of  Boys^ 

At  birth Weight 7|  pounds. 

Height 20^  inches. 

Chest 13i      " 

Head 14 

One  year Weight 21  pounds. 

Height 2^    inches. 

Chest 18 

Head 18 

Two  years Weight 26^  pounds. 

Height 32i  inches. 

Chest 19 

Head 19 

Three  years. . .Weight 31    pounds. 

Height 35    inches. 

Chest 20 

Head 19ir      " 

Four  years . . .  Weight 35    pounds. 

Height 38    inches. 

Chest 20f      " 

Head 19|      " 

^  Weights  for  the  first  four  years  are  without  clothes. 

The  weight  of  girls  is  on  the  average  about  one  pound  less 
than  boys.     They  are  about  the  same  in  height. 

Charts  showing  weight  curve  for  the  first  year,  and  from  one 
year  to  fourteen  years  are  given  at  the  end  of  this  book. 


36    THE  CARE  AND  FEEDING  OF  CHILDREN 

Five  years Weight 41    pounds. 

Heigiit 41^  inches. 

Chest 2H     " 

Head 20^     " 

Six  years Weight 45    pounds. 

Height 44    inches. 

Chest 23 

Seven  years. .  .Weight 49|  pounds. 

Height 46    inches. 

Chest 23^      " 

Eight  y  ars. .  .Weight 54^  pounds. 

Height 48    inches. 

Chest 24i     " 

Nine  years Weight 60    pounds. 

Height .". 50    inches. 

Chest 25 

Ten  years Weight 66i  pounds. 

Height 52    inches. 

Chest 26 

The  above  weights  are  with  ordinary  house  clothes. 

DENTITION" 

How  many  teeth  are  there  in  the  first  set? 
Twenty. 

What  is  the  time  of  their  appearance? 

The  two  central  lower  teeth  are  usually  the  first 
to  appear,  and  come  from  the  fifth  to  the  ninth 
month;  next  are  the  four  upper  central  teeth,  which 
come  from  the  eighth  to  the  twelfth  month.  The 
other  two  lower  central  teeth  and  the  four  front 
double  teeth  come  from  the  twelfth  to  the  eighteenth 
-jnonth.     Then  follow  the  four  canine  teeth,  the  two 


DENTITION  37 


upper  ones  being  known  as  the  "  eye  teeth,"  and  the 
two  lower  as  the  "  stomach  teeth " ;  they  generally 
come  between  the  eighteenth  and  the  twenty-fourth 
month.  The  four  back  double  teeth,  which  complete 
the  first  set,  come  between  the  twenty-fourth  and 
thirtieth  month. 

At  one  year  a  child  usually  has  six  teeth. 

At  one  and  a  half  years,  twelve  teeth.^^- 

At  two  years,  sixteen  teeth. 

At  two  and  a  half  years,  twenty  teeth. 

What  are  the  causes  of  variation? 

The  time  of  appearance  of  the  teeth  varies  in 
different  families;  in  some  they  come  very  early, 
in  others  much  later.  The  teeth  may  come  late  as 
a  result  of  prolonged  illness  and  also  from  rickets. 

What  symptoms  are  commonly  seen  with  teeth- 
ing? 

In  healthy  children  there  is  very  often  fretful- 
ness  and  poor  sleep  for  two  or  three  nights;  there 
may  be  loss  of  appetite,  so  that  only  one  half  the 
usual  amount  of  food  is  taken;  there  is  salivation 
or  drooling,  and  often  slight  fever;  there  may  be 
some  symptoms  of  indigestion,  such  as  vomiting  or 
the  appearance  of  undigested  food  in  the  stools.  In 
delicate  children  all  these  symptoms  may  be  much 
more  severe. 


38         THE  CARE  AND  FEEDING  OF   CHILDREN 

How  long  do  these  symptoms  last? 
Usually  only  three  or  four  days;  but  there  may 
be  no  gain  in  weight  for  two  or  three  weeks. 

What  is  the  cause  of  most  of  the  other  symptoms 
attributed  to  teething? 

IN'early  all  of  them  come  from  indigestion  due  to 
bad  feeding. 


PAET  II 
INFANT    FEEDING 


II 

INFANT  FEEDING 

What  is  the  best  infant  food? 

Mother's  milk. 

Of  what  is  mother's  milk  composed? 

Thirteen  parts  solids  and  eighty-seven  water. 

What  are  the  solids? 

Fat,  sugar,  proteids,  and  salts. 

What  is  the  fat? 

The  cream. 

What  is  the  sugar? 

It  is  lactose,  or  milk  sugar. 

What  are  the  proteids? 

The  curd  of  the  milk. 

Are  all  these  elements  necessary? 

Yes;  we  cannot  expect  to  rear  a  healthy  infant 
unless  they  are  all  in  his  food. 

Of  what  use  is  the  fat? 

It  is  needed  for  the  growth  of  bones,  nerves,  the 
fat  of  the  body,  and  the  production  of  heat. 

Of  what  use  is  the  sugar? 

It  is  needed  for  the  production  of  heat,  and  to 
make  fat  in  the  body. 

41 


42         THE  CARE  AND  FEEDING  OF  CHILDREN 

Of  what  use  are  the  proteids? 

Thej  are  needed  for  the  growth  of  the  body  cells, 
such  as  those  of  the  blood,  the  organs,  and  the  muscles. 

Of  what  use  are  the  salts? 

Particularly  for  the  growth  of  bone. 

Of  what  use  is  the  water? 

By  means  of  the  water  the  food  is  kept  in  a  state 
of  minute  subdivision  or  in  solution,  so  that  the  deli- 
cate organs  of  the  infant  can  digest  it.  It  is  also 
necessary  to  enable  the  body  to  get  rid  of  its  waste. 

2SrURSING 

Why  should  mothers  nurse  their  children? 

First,  because  there  is  no  perfect  substitute  for 
good  breast-feeding.  Secondly,  statistics  show  that 
the  mortality  of  bottle-fed  infants  during  the  first 
year  is  fully  three  times  as  great  as  that  of  those 
who  are  breast-fed. 

At  what  period  is  nursing  of  greatest  importance? 

During  the  first  two  or  three  months,  to  give  the 
child  a  proper  start.  At  this  time  of  life  the  mor- 
tality is  highest  and  artificial  feeding  is  most  difficult. 

When  should  maternal  nursing  not  he  attempted? 

If  the  mother  has  or  has  had  tuberculosis  or  any 
other  serious  chronic  disease,  or  is  herself  in  very 
delicate  health,  she  should  not  try.    She  is  likely  soon 


NURSING 


43 


to  fail  in  nourishing  her  child,  and  the  attempt  may 
do  herself  much  harm  as  well  as  injure  the  child. 

Hovj  often  should  infants  he  nursed  during  the 
first  two  days  of  life? 

Usually  only  four  or  five  times  daily,  since  there 
is  very  little  milk  secreted  at  this  time. 

When  does  the  milk  come  in  abundance  f 

Usually  on  the  third  day,  sometimes  not  until 
the  fourth  or  fifth  day. 

Should  the  infant  he  fed  anything  additional 
during  the  first  two  days? 

Usually  not;  if  much  food  were  necessary,  we 
m.ay  be  sure  E'ature  would  have  provided  it.  Water, 
however,  should  be  given  regularly. 

How  frequently  should  an  infant  he  nursed  dur- 
ing the  first  week? 

After  the  third  day,  every  two  hours  during  the 
day  and  twice  during  the  night.  The  frequency 
during  the  rest  of  the  first  year  is  given  in  the  fol- 
lowing table: 


Period. 

Nursings  in 
24  hours. 

Interval  by  day. 

Night  nursings 
(10  p.  M.  to  6  A.  M.). 

1st  and  2d  day 

3  days  to  6  weeks 

6  weeks  to  3  months. 

3  to  5  months '. . . 

5  to  12  months 

4 
10 
8 
7 
6 

6  hours. 

2  " 
2i    '* 

3  « 
3      « 

1 
2 
2 

1 

0 

44         THE  CARE  AND  FEEDING  OF  CHILDREN 

How  long  should  the  child  he  kept  at  the  hreasf 
for  one  nursing? 

ISTot  over  twenty  minutes. 

Should  the  child  take  both  breasts  at  one  nursing  f 
If  the  milk  is  very  abundant  one  breast  may  be 
sufficient,  otherwise  both  breasts  may  be  taken. 

What  are  the  important  things  to  be  attended  to 
in  nursing? 

First,  regularity;  it  is  just  as  important  as  in 
the  case  of  bottle-feeding.  Secondly,  the  nipples 
should  be  kept  clean  by  being  washed  after  every 
nursing. 

What  should  be  the  diet  of  a  nursing  mother? 

She  should  have  a  simple  but  generous  diet  with, 
plenty  of  fluids;  three  regular  meals  may  be  given, 
and  gruel,  milk,  or  cocoa  at  bed-time  and  sometimes 
between  meals.  She  may  take  eggs,  cereals,  most 
soups,  and  nearly  all  vegetables,  avoiding  sour  fruits, 
salads,  pastry,  and  most  desserts.  Meat  should  not 
be  taken  more  than  twice  daily,  and  in  many  cases 
but  once.  She  should  take  but  little  tea  or  coffee, 
and  ordinarily  no  wine  or  beer. 

Are  fruits  likely  to  disturb  a  nursing  infant? 
Sour  fruits  in  some  cases  may  do  so,  but  sweet 
fruits  and  most  cooked  fruits  are  useful. 


NURSING  45 


What  else  is  important  in  the  life  of  the  nursing 
mother? 

She  should  lead  a  simple  natural  life;  should 
have  regular  out-of-door  exercise,  preferably  walking 
or  driving,  as  soon  after  her  confinement  as  her  con- 
dition will  permit.  She  should  have  regular  move- 
ments from  the  bowels  daily.  She  should  be  as  free 
as  possible  from  unnecessary  cares  and  worry;  her 
rest  at  night  should  be  disturbed  as  little  as  possible ; 
she  should  lie  down  for  at  least  one  hour  in  the  mid- 
dle of  the  day. 

Does  the  nervous  condition  of  the  mother  affect 
the  milk? 

Very  much  more  than  her  diet;  worry,  anxiety, 
fatigue,  loss  of  sleep,  household  cares,  social  dissipa- 
tion, etc.,  have  more  than  anything  else  to  do  with 
the  failure  of  the  modern  mother  as  a  nurse.  Uncon- 
trolled emotions,  grief,  excitement,  fright,  passion, 
may  cause  milk  to  disagree  with  the  child ;  at  times 
they  may  excite  acute  illness,  and  at  other  times  they 
may  cause  a  sudden  and  complete  disappearance  of 
the  milk. 

Does  menstruation  affect  the  milk? 

In  nearly  all  cases  the  quantity  of  milk  is  less- 
ened so  that  the  infant  is  not  satisfied  and  may  gain 
less  in  weight  or  not  at  all.     In  many  cases  the  qual- 


46         THE  CARE  AND   FEEDING  OF  CHILDREN 

itj  of  the  milk  is  also  affected  to  such  a  degree  as  to 
cause  slight  disturbances  of  digestion,  like  restless- 
ness, colic,  or  some  derangement  of  the  bowels.  In 
a  few,  attacks  of  acute  indigestion  are  excited. 

7s  regular  menstruation  a  reason  to  stop  nursing? 

!N^ot  invariably;  as  a  rule  both  functions  do  not 
go  on  together.  But  if  the  child  is  gaining  regu- 
larly in  weight  between  the  periods,  nursing  may  be 
continued  indefinitely,  although  it  may  be  well  to 
feed  the  infant  wholly  or  in  part  during  the  first 
day  or  two  that  the  mother  is  unwell. 

What  symptoms  indicate  that  a  nursing  infant  is 
well  nourished? 

The  child  has  good  color,  sleeps  two  or  three 
hours  after  nursing,  or,  if  awake,  is  quiet,  good- 
natured,  and  apparently  comfortable.  It  has  normal 
movements  of  the  bowels  and  gains  weight  steadily. 

What  symptoms  indicate  that  a  child  who  is 
nursing  is  not  properly  nourished? 

It  does  not  gain  and  may  even  lose  in  weight. 
It  no  longer  exhibits  its  usual  energy  and  playful- 
ness, but  is  either  listless  and  indifferent  or  cross, 
fretful  and  irritable,  and  is  apt  to  sleep  poorly.  It 
grows  pale  and  anaemic  and  its  tissues  become  soft 
and  flabby.  When  the  milk  is  scanty  it  will  often 
nurse  a  long  time  at  the  breasts,  sometimes  three 


NURSING  47 


quarters  of  an  hour,  before  stopping.  At  other  times 
it  may  take  the  breast  for  a  moment  only,  and  then 
turn  away  in  apparent  disgust. 

What  should  he  done  in  such  cases? 

This  depends  upon  the.  severity  of  the  symptoms 
and  how  long  they  have  lasted.  If  the  child  has 
made  no  gain  for  three  or  four  weeks,  or  is  losing 
weight,  immediate  weaning  will  probably  be  neces- 
sary ;  in  any  case,  other  food  in  addition  to  the  breast 
milk  should  be  given  at  once.  One  may  begin  by 
alternating  the  nursing  and  the  bottle-feeding  and 
increase  the  number  of  bottle-feedings  as  may  be 
indicated  by  the  results. 

Is  there  any  objection  to  a  hahy  being  partly 
nursed  and  partly  fed? 

^one  whatever;  it  is  often  better  from  the  out- 
set to  feed  the  baby  during  the  night,  in  order  not 
to  disturb  the  mother's  rest.  If  the  mother  has  only 
milk  enough  for  two  or  three  nursings  a  day,  this 
should  be  continued  so  long  as  her  milk  agrees  with 
the  baby.  Even  a  small  amount  of  breast  milk 
greatly  improves  a  child's  nutrition. 

What  symptoms  indicate  that  the  mother's  milk 
disagrees  with  the  child? 

The  child  suffers  from  almost  constant  discom- 
fort;  sleeps  little  and  then  restlessly,  cries  a  great 


48         THE  CARE  AND   FEEDING  OF  CHILDREN 

deal,  belches  gas  from  the  stomach,  and  passes  much 
by  the  bov/els,  or  if  not  passed,  the  gas  accumulates 
and  causes  abdominal  distention  and  colicky  pain. 
There  may  be  vomiting,  but  more  often  the  trouble 
is  intestinal.  Sometimes  the  bowels  are  constipated, 
but  usually  the  movements  are  frequent,  loose,  green, 
contain  mucus  and  are  passed  with  much  gas. 

What  should  he  done  under  these  circumstances^ 
If  the  symptoms  have  persisted  for  two  or  three 
weeks  and  the  child  is  not  gaining  in  weight,  there 
is  little  chance  of  improvement,  and  the  child  should 
be  taken  from  the  breast  at  once.  If  there  is  some 
gain  in  weight,  one  may  try  for  a  little  longer,  en- 
deavouring to  improve  the  mother's  milk  by  rest, 
fresh  air,  careful  diet,  etc.  However,  one  should 
always  realize  that  the  trouble  is  with  the  milk,  not 
with  the  child. 

What  changes  should  he  made  if  a  nursing  infant 
hahitually  vomits? 

If  this  occurs  soon  after  nursing,  the  infant  has 
usually  taken  too  much  and  the  time  of  nursing 
should  be  shortened,  or  one  breast  may  be  given 
instead  of  two;  the  nursing  should  also  be  inter- 
rupted by  occasional  rests,  so  that  the  milk  is  not 
taken  too  fast. 

If  the  vomiting  occurs  some  time  after  nursing 


WEANING  49 


and  is  repeated,  it  is  a  sign  of  indigestion;  often 
"because  the  milk  is  too  rich  in  fat.  The  intervals 
Ijetween  nursings  should  then  be  lengthened;  the 
"breast  milk  may  be  diluted  by  giving  one  or  two 
tablespoonfuls  of  plain  boiled  water,  lime-water,  or 
barley-water,  five  or  ten  minutes  before  nursing ;  the 
mother  should  eat  less  hearty  food,  especially  less 
meat. 

What  should  he  done  if  the  infant  has  frequent 
habitual  colic? 

This  is  usually  because  the  milk  is  too  rich  in 
proteids;  the  mother  should  take  more  out-of-door 
exercise,  eat  less  meat,  and  seek  to  control  her  emo- 
tions; all  causes  of  worry  should  be  removed. 

Can  constipation  in  a  nursing  infant  he  con- 
trolled through  the  mother  s  milhf 

Only  to  a  limited  extent.  It  is  important  that 
the  mother's  bowels  be  regular  and  her  digestion 
good.  An  increase  in  the  meat  and  milk  of  her  diet 
is  sometimes  beneficial. 

WEAITING 

At  what  age  should  the  child  he  weaned  from 
the  hreastf 

"Usually  weaning  should  be  begun  at  nine  or  ten 
months  by  substituting  one  feeding  a  day  for  one 


<vB»^A.^r>» 


50         THE   CARE  AND   FEEDING  OF  CHILDREN 


nursing,  later  two  feedings,  and  thus  gradually  the 
child  is  to  be  taken  from  the  breast  altogether. 

What  is  the  principal  reason  for  weaning  earlier  ? 

The  most  important  one  is  that  the  child  is  not 
thriving — not  gaining  in  weight  and  not  progress- 
ing normally  in  its  development.  Serious  illness 
of  the  mother,  or  pregnancy,  may  make  weaning 
necessary. 

At  what  age  should  the  weaning  he  completed? 

Generally  at  one  year.  In  summer  it  may  some- 
times be  advisable  to  nurse  an  infant  a  little  longer 
rather  than  wean  in  warm  weather;  but  even  then 
the  dangers  of  weaning  are  much  less  than  those  of 
continuing  to  nurse,  as  is  so  often  done,  after  the 
milk  has  become  very  scanty  and  poor  in  quality. 

When  should  a  child  who  is  weaned  from  the 
breast  he  taught  to  drinJc  from  the  cup,  and  when 
to  take  the  hottle? 

If  weaning  is  done  as  early  as  the  eighth  or  ninth 
month  it  is  better  to  give  the  bottle;  if  from  the 
tenth  to  the  twelfth  month  the  infant  should  be 
taught  to  drink  or  be  fed  with  a  spoon. 

How  may  some  of  the  difficulties  in  weaning  he 
overcome  ? 

By  feeding  every  nursing  infant  once  a  day  or 


WEANING  51 


by  giving  it  water  regularly  from  a  feeding-bottle. 
It  then  becomes  accustomed  to  the  bottle.  This  is  a 
matter  of  great  convenience  during  the  whole  period 
of  nursing  when  the  mother  or  nurse  is  from  neces- 
sity away  from  the  child  for  a  few  hours;  when 
more  feeding  is  required  at  weaning  time  the  child 
does  not  object. 

When  should  a  child  he  iveaned  from  the  bottle? 

With  children  who  are  not  ill,  weaning  from  the 
bottle  should  invariably  be  begun  at  the  end  of  the 
first  year,  and  after  a  child  is  thirteen  or  fourteen 
months  old  the  bottle  should  not  be  given  except  a^ 
the  night  feeding. 

'   7s  there  any  ohj^xtion  to  the  child's  taking  the 
bottle  until  it  is  two  or  three  years  old? 

There  are  no  advantages  and  some  serious  objec- 
tions. Older  children  often  become  so  attached  to 
the  bottle  that  only  wdth  the  greatest  difficulty  can 
they  be  made  to  give  it  up.  Frequently  they  will 
refuse  all  solid  food,  and  will  take  nothing  except 
from  the  bottle  so  long  as  it  is  given,  and  when 
finally  at  three  or  four  years,  it  is  taken  away,  they 
will  not  touch  milk  during  the  rest  of  their  child- 
hood. The  difficulty  is  here  that  children  form  the 
"  bottle  habit."  This  habit  is  troublesome,  unneces- 
sary, and  should  by  all  means  be  prevented.     An 


53    THE  CARE  AND  FEEDING  OF  CHILDREN 

exclusive  diet  of  milk  for  children  of  two  or  three 
years  often  results  in  ansemia  and  malnutrition. 

How  should  one  train  a  child  to  do  without  the 
bottle? 

This  is  usually  very  easy  if  it  is  begun  at  one 
year.  The  milk  should  be  poured  into  a  tiny  glass  or 
cup  and  little  by  little  the  child  is  taught  to  drink ;  at 
first  only  a  small  portion  of  the  food  is  taken  in  this 
way,  the  balance  being  given  from  the  bottle ;  but  in 
the  course  of  a  few  weeks  the  average  infant  learns 
to  drink  from  a  cup  without  difficulty,  and  all  the 
food  can  be  so  given. 

If  the  child  is  two  or  more  years  old,  the  only 
effective  means  of  weaning  from  the  bottle  is  through 
hunger.  The  bottle  should  be  taken  away  at  once 
and  entirely,  and  nothing  allowed  except  milk  from 
a  cup  until  the  child  takes  this  willingly.  Sometimes 
a  child  will  go  an  entire  day  without  food,  occasion- 
ally as  long  as  two  days,  but  one  should  not  be 
alarmed  on  this  account  and  yield.  This  is  a  matter 
of  the  child's  will  and  not  of  his  digestion,  and  when 
once  he  has  been  conquered  it  is  seldom  that  any 
further  trouble  is  experienced.  As  soon  as  a  child  has 
learned  to  drink  his  milk  from  a  cup,  cereals  and 
other  solid  foods  may  gradually  be  added  to  the  diet. 
The  educational  value  of  such  training  is  not  the 
least  important  consideration. 


WEANING  5» 


Can  a  hahy  just  weaned  taJce  cow's  milk  of  the 
same  proportions  as  one  of  the  same  age  who  has 
had  cow's  milk  from  hirth? 

Very  rarely ;  to  give  a  baby  who  has  had  nothing 
but  the  breast  from  birth,  plain  cow's  milk,  or  even 
that  milk  which  a  bottle-fed  baby  of  the  same  age 
might  take,  is  almost  certain  to  cause  indigestion. 
The  change  in  the  food  is  quite  a  marked  one,  and 
should  be  made  gradually  by  beginning  with  a  very 
weak  milk  and  increasing  its  strength  as  the  baby 
becomes  accustomed  to  take  cow's  milk. 

What  would  he  the  proper  proportions  for  an 
infant  weaned  at  four  or  five  months? 

About  the  same  as  for  a  healthy  bottle-fed  infant 
of  two  months;  the  quantity  of  course  should  be 
larger.  The  food  can  in  most  cases  be  gradually 
increased  so  that  in  two  or  three  weeks  the  usual 
strength  for  the  age  can  be  taken. 

What  would  he  the  proper  proportions  for  an  in- 
fant weaned  at  nine  or  ten  months? 

About  the  same  as  for  a  bottle-fed  infant  at  four 
or  five  months,  to  be  increased  as  indicated  above. 

Will  not  a  child  lose  in  weight  when  placed  upon, 
so  low  a  diet? 

Very  often  it  will  do  so  for  the  first  week  or  two, 
but  after  that  wall  gain  quite  regularly;  the  acute 


64    THE  CARE  AND  FEEDING  OF  CHILDREN 

indigestion,  however,  which  generally  accompanies 
the  use  of  stronger  milk  will,  in  most  cases,  cause  a 
greater  loss. 

ARTIFICIAL    FEEDING 

What  foods  contain  all  the  elements  'present  in 
■mother  s  milkf 

The  milk  of  other  animals, — cow's  milk  being 
the  only  one  which  is  available  for  general  use. 

Is  it  not  possible  for  infants  to  thrive  upon  other 
foods  than  those  containing  fresh  milk? 

They  may  do  so  for  a  time,  but  never  perma- 
nently. The  long-continued  use  of  other  foods  as 
the  sole  diet  is  attended  with  great  risk. 

What  are  the  dangers  of  such  foods? 

Frequently  scurvy  is  produced,  often  rickets,  and 
in  other  cases  simply  a  condition  of  general  malnu- 
-trition, — the  child  does  not  thrive,  is  pale,  and  its 
muscles  are  soft  and  flabby. 

'THE  SELECTION  AND  CARE  OF  MILK  USED  FOR  INFANT 
FEEDING 

What  are  the  essential  points  in  milk  selected  for 
ihe  feeding  of  infants? 

That  it  comes  from  healthy  cows,  and  that  it  is 
clean  and  fresh. 


THE  SELECTION  AND  CARE  OF  MILK  55 

Is  it  not  important  to  select  a  rich  milk? 

By  no  means;  in  fact  the  very  rich  milk  of 
highly  bred  Jerseys  and  >  Alderneys  has  not  been 
found  nearly  so  satisfactory  in  infant  feeding  as  that 
from  some  other  herds,  such,  for  example,  as  the 
common  "  grade  cows." 

Which  is  the  better ,  milk  from  one  cow  or  the 
mixed  milk  of  several  cows? 

The  mixed,  or  "  herd  milk,"  is  usually  to  be  pre- 
ferred, since  it  varies  little  from  day  to  day;  while 
that  from  a  single  cow  may  vary  considerably. 

How  fresh  is  it  important  that  cow's  milk  should 
he  for  the  best  results  in  infant  feeding? 

This  depends  very  much  upon  the  season,  and 
how  carefully  milk  is  handled.  As  ordinarily  han- 
dled at  the  dairy  and  in  the  home,  milk  should  not 
be  used  for  infants  in  winter  after  it  is  forty-eight 
hours  old;  in  summer  not  after  it  is  twenty-four 
hours  old,  and  it  may  be  unsafe  in  a  much  shorter 
time.  When  handled  with  especial  care  milk  may  be 
safe  for  a  longer  time. 

What  are  the  two  essentials  in  handling  milk? 

1.  That  it  be  kept  clean  and  free  from  contami- 
nation. This  necessitates  that  cows,  stables,  and 
milkers  be  clean,  and  that  transportation  be  in  sealed 
bottles ;  also  that  those  who  handle  the  milk  are  them- 


56         THE  CARE  AND  FEEDING  OP  CHILDREN 

selves  healthy  and  do  not  come  in  contact  with  any 
contagious  disease.  All  milk-pails,  bottles,  cans,  and 
other  utensils  with  which  the  milk  comes  in  contact 
should  be  sterilized  shortly  before  they  are  used,  by 
steam  or  boiling  water. 

2.  That  it  be  cooled  immediately  after  leaving 
the  cows,  and  kept  at  as  low  a  temperature  as  possi- 
ble; to  be  efficient  this  should  not  be  above  50°  F. 

Milk  produced  under  hygienic  conditions  and 
handled  with  special  care  is  sold  in  bottles  in  a  num- 
ber of  cities  under  the  name  of  "  certified,"  "  guar- 
anteed," or  "  inspected  "  milk.  When  available  such 
milk  should  be  used  for  infants.  Of  course  the  extra 
care  bestowed  in  its  production  and  transportation 
increases  the  cost  of  the  milk,  but  the  best  will  usually 
be  found  in  the  end  to  be  the  cheapest. 

How  should  milk  he  handled  in  the  home  when 
obtained  fresh  from  the  cows? 

That  to  be  used  for  infants  should  be  strained 
through  a  thick  layer  of  absorbent  cotton  or  several 
thicknesses  of  cheese-cloth  into  quart  glass  jars  or 
milk  bottles  which  should  be  covered  and  cooled  im- 
mediately, best  by  placing  the  bottles  quite  up  to 
their  necks  in  ice  water  or  cold  spring  water,  where 
they  should  stand  for  at  least  half  an  hour.  That 
required  for  children  who  take  plain  milk  may  now 


THE   SELECTION  AND  CARE  OF  MILK  57 

be  poured  into  half-pint  bottles,  stopped  with  cotton, 
and  put  in  the  ice-chest,  or  the  coolest  place  possible. 
This  first  rapid  cooling  is  very  important  and  adds 
much  to  the  keeping  qualities  of  the  milk.  Milk 
loses  its  heat  very  quickly  when  cooled  in  water, 
but  very  slowly  when  it  is  simply  placed  in  a  cold 
room.  After  standing  four  or  five  hours  the  top- 
milk  may  be  removed;  after  twelve  to  sixteen  hours 
the  cream  may  be  removed. 

Hoio  should  milk  he  handled  when  bottled  milk 
is  purchased? 

It  should  be  cooled  as  just  described,  as  its  tem- 
perature is  usually  somewhat  raised  during  trans- 
portation. If  it  has  been  bottled  at  a  dairy,  -the 
cream  or  the  top-milk  may  be  removed  after  an  hour 
or  so. 

How  should  milk  and  cream  he  handled  when 
they  are  purchased  in  hulk? 

Such  milk  should  never  be  used  for  infants  when 
it  is  possible  to  obtain  bottled  milk,  as  it  is  much 
more  liable  to  contamination.  Both  cream  and  milk 
should  be  poured  at  once  into  covered  vessels  and 
kept  in  the  coolest  place  possible.  The  cream  and 
top-milk  will  seldom  rise  upon  such  milk  with  any 
satisfactory  regularity. 


58    THE  CARE  AND  FEEDING  OP  CHILDREN 

What  are  the  important  things  to  he  secured  in 
nursery  refrigerators  ? 

Absolute  cleanliness  is  essential;  hence  the  inner 
portion  should  be  of  metal.  Those  made  entirely 
of  metal  are  unsatisfactory  as  in  them  the  ice  melts 
very  quickly.  If  the  ordinary  metal  refrigerator 
sold  is  encased  in  a  wooden  box,  we  have  the  best 
form.  Another  easy  way  of  securing  the  same  result 
is  to  make  for  the  refrigerator  a  covering  or  "  cosey  " 
of  felt  or  heavy  quilting,  which  can  be  easily  re- 
moved when  wet  or  soiled. 

The  compartments  of  the  refrigerator  should  be 
so  arranged  that  the  bottles  of  milk  are  either  in 
■contact  with  the  ice  or  very  near  it.  The  supply  of 
ice  should  be  abundant.  Often  the  amount  of  ice  is 
so  small,  and  the  bottles  so  far  away,  that  the  tem- 
perature of  the  milk  is  never  below  60°  or  65°  F. 
To  be  really  effective  a  refrigerator  should  have  a 
temperature  where  the  milk  is  placed  of  not  over 
50°  F.  The  temperature  should  be  tested  with  the 
nursery  thermometer  from  time  to  time  to  ascertain 
what  results  are  being  obtained.  Spoiled  milk  owing 
to  a  faulty  refrigerator  is  to  be  blamed  for  many 
attacks  of  acute  illness  among  infants.  'Next  to  the 
feeding-bottles  it  is  the  one  thing  in  the  nursery 
which  should  receive  the  closest  attention. 


THE  MODIFICATION  OF  COW'S  MILK  59 


What  is  meant  by  the  modification  of  coiv's  milk? 

Changing  its  proportions  so  that  it  can  be  more 
easily  digested. 

Is  it  'possible  to  modify  cow's  milk  so  as  to  make 
it  a  perfect  substitute  for  mother's  milk? 

It  is  not.  Although  we  can  modify  cow's  milk 
so  that  the  great  majority  of  infants  can  digest  it 
and  thrive  on  it,  it  must  be  remembered  that  there 
are  differences  which  cannot  be  wholly  overcome. 
There  are  certain  peculiar  qualities  in  mother's  milk 
which  cow's  milk  does  not  contain. 

How  is  this  milk,  whose  proportions  have  been 
changed,  distinguished  from  the  unchanged  milk? 

The  changed  milk  is  usually  called  "  modified 
milk " ;  the  original  unchanged  milk  is  known  as 
"  plain  milk,"  "  whole  milk,"  "  straight  milk,"  or 
is  referred  to  simply  as  "  milk." 

What  are  the  principal  differences  between  cow's 
milk  and  mother's  milk? 

Cow's  milk  has  only  a  little  more  than  half  as 
much  sugar;  it  has  nearly  three  times  as  much  pro- 
teids  and  salts ;  its  proteids  and  fat  are  different  and 
much  more  difficult  of  digestion;  its  reaction  is  de- 
cidedly acid,  that  of  mother's  milk  is  faintly  acid  or 
neutral. 


60    THE  CARE  AND  FEEDING  OF  CHILDREN 

Are  there  any  other  important  things  to  he  con- 
sidered ? 

Yes;  mother's  milk  is  always  fed  fresh  and  is 
practically  sterile.  Cow's  milk  is  generally  kept 
twenty-four  hours  and  sometimes  much  longer.  It 
is  always  to  a  greater  or  less  degree  contaminated 
by  dirt  and  germs,  the  number  of  which  increases 
rapidly  (1)  with  the  age  of  the  milk;  (2)  in  propor- 
tion to  amount  of  the  dust  or  dirt  which  enters  it ; 
(3)  with  any  increase  in  the  temperature  at  which 
the  milk  is  kept. 

It  is  just  as  important  for  success  in  infant  feed- 
ing that  these  conditions  receive  attention  as  that 
the  proportions  of  the  different  elements  of  the  milk 
are  right. 

Hoiu  is  the  acidity  of  cow's  milk  overcome? 

By  the  addition  of  lime-water  or  bicarbonate  of 
soda.  If  lime-water  is  used,  one  ounce  to  twenty 
ounces  of  food  is  generally  required ;  if  soda  is  used, 
twenty  grains  to  twenty  ounces  of  food. 

If  there  is  a  tendency  to  constipation  the  milk 
of  magnesia  (Phillips's)  may  be  used;  from  one  half 
to  one  teaspoonful  being  added  to  each  twenty  ounces 
of  food. 

How  is  the  sugar  best  increased? 

By  adding  milk  sugar  to  the  food ;  one  ounce  to 


THE  MODIFICATION  OF  COWS  MILK  61 

eacli  twenty  ounces  of  food  will  give  the  proper 
quantity  for  the  first  three  or  four  months.  This 
will  make  the  proportion  about  the  same  (between  6 
and  7  per  cent)  as  in  mother's  milk. 

How  should  the  sugar  he  prepared? 

Simply  dissolved  in  boiled  water ;  if  the  solution 
is  not  clear,  or  if  there  is  a  deposit  after  standing, 
it  should  be  filtered  by  pouring  through  a  layer  of 
absorbent  cotton,  half  an  inch  thick,  which  is  placed 
in  an  ordinary  funnel. 

Will  not  cane  (granulated)  sugar  answer  as  well? 

!N"ot  as  a  rule;  however,  there  are  many  infants 
who  get  on  very  well  when  cane  sugar  is  used.  It 
has  the  advantage  of  being  much  cheaper.  A  good 
grade  of  milk  sugar  is  somewhat  expensive,  costing 
from  twenty-five  to  sixty  cents  a  pound,  and  cheap 
samples  are  apt  to  contain  impurities. 

If  cane  sugar  is  used,  what  amount  should  he 
added? 

Considerably  less  than  of  the  milk  sugar.  Usu- 
ally about  half  the  quantity  (half  an  ounce  to  twenty 
ounces  of  food)  is  as  much  as  most  infants  can  di- 
gest. If  the  same  quantity  is  used  as  of  the  milk 
sugar,  the  food  is  made  unduly  sweet,  and  the  sugar 
is  likely  to  ferment  in  the  stomach  and  cause  colic. 


62         THE  CARE  AND  FEEDING  OF   CHILDREN 

Is  not  the  purpose  of  the  sugar  to  sweeten  the 
food  in  order  to  make  it  palatable? 

Not  at  all;  although  it  does  that,  its  real  use  is 
to  furnish  one  of  the  essential  elements  needed  for 
the  growth  of  the  body,  and  the  one  that  is  required 
by  young  infants  in  the  largest  quantity. 

How  do  we  know  that  this  is  so  f 

By  the  fact  that  in  good  breast  milk  the  amount 
of  sugar  is  greater  than  that  of  the  fat,  proteids,  and 
salts  combined. 

We  have  seen  that  pow's  milk  has  nearly  three 
times  as  much  proteids  (curd)  and  salts  as  mother  s 
milk.    How  are  these  to  he  diminished? 

By  diluting  the  milk. 

Will  it  he  sufficient  to  dilute  the  milk  twice  {i.  e., 
add  two  parts  of  water  to  one  part  of  milk)  ? 

'Eol  for  a  very  young  infant.  Although  this  will 
give  about  the  quantity  of  proteids  present  in  moth- 
er's milk,  the  proteids  of  cow's  milk  are  so  much 
more  difficult  for  the  infant  to  digest,  that  in  the 
beginning  it  should  be  diluted  five  or  six  times  for 
most  infants. 

If  cow's  milk  is  properly  diluted  and  lime-water 
and  sugar  added  does  it  then  resemble  mother  s  milk? 
!N^o;  the  mixture  contains  less  fat. 


THE  MODIFICATION  OF  COW'S  MILK  63 

7s  it  desirable  to  increase  the  fat  to  the  proportioyi 
present  in  mother  s  milhf 

On  account  of  the  difference  in  digestibility  it  is 
usually  impossible  to  give  to  young  infants  as  much 
fat  in  cow's  milk  as  is  present  in  good  mother's  milk. 
For  most  infants  it  is,  however,  desirable  to  give 
more  fat  than  is  contained  in  cow's  milk  when  this 
has  been  simply  diluted. 

What  is'  the  easiest  way  to  secure  a  milJc  which 
contains  the  proper  proportion  of  fatf 

By^increasing  the  fat  in  the  milk  before  dilution. 
It  may  be  done  by  using  top-milk  or  a  mixture  of 
milk  and  cream. 

What  is  top-milk? 

It  is  the  upper  layer  of  milk  removed  after 
standing  a  certain  number  of  hours  in  a  milk  bottle, 
glass  jar,  or  any  tall  vessel  with  straight  sides.  It 
contains  most  of  the  cream  and  some  of  the  milk 
just  below. 

The  strength  of  the  top-milk  is  measured  by  the 
fat  it  contains — e.  g.,  7-per-cent  milk  contains  7  per 
cent  fat,  etc.  This  is  the  top-milk  of  most  use  in 
infant  feeding. 

When  and  how  should  top-milk  he  removed? 
If  milk  fresh  from  the  cow,  or  before  the  cream 
has  risen,  is  put  into  bottles  and  rapidly  cooled,  the 


64         THE  CARE  AND  FEEDING  OF  CHILDREN 

top-milk  may  be  removed  in  as  short  a  time  as  four 
hours.  In  the  case  of  bottled  milk  it  makes  little 
difference  if  it  stands  a  longer  time,  even  until  the 
next  day.  The  best  means  of  removing  it  is  by  a 
small  cream-dipper  ^  holding  one  ounce ;  although  it 
may  be  taken  off  by  a  spoon  or  siphon.  It  should  not 
be  poured  off. 

Does  the  upper  half  always  contain  7-per-cent 
fat? 

"No ;  this  varies  with  the  length  of  time  the  milk 
has  stood,  and  still  more  with  the  richness  of  the 
milk  used. 

The  richness  of  the  milk  depends  on  several  fac- 
tors :  whether  it  is  from  a  herd  or  a  single  cow,  also 
on  the  breed  of  the  cow  and  on  the  manner  of  feed- 
ing. In  good  average  milk  the  cream  forms  about 
one-eighth  of  the  whole  amount  after  the  milk  has 
stood  four  or  ^ve  hours. 

How  can  we  obtain  a  7-per-cent  top-milk  with  the 
different  hinds  of  cow's  milk? 

From  a  rather  poor  milk,  by  removing  the  upper 
eleven  ounces  from  a  quart,  or  about  one  third. 

*  Obtained  from  any  of  the  Walker-Gordon  milk  laboratories, 
from  James  Dougherty,  No.  411  West  59th  Street,  New  York,  and 
from  many  druggists.     Price,  20  cents. 


THE  MODIFICATION  OF  COW'S  MILK  65 

From  a  good  average  milk,  by  removing  the  upper 
sixteen  ounces,  or  one  half. 

Erom  a  rich  Jersey  milk,  by  removing  the  upper 
twenty-two  ounces,  or  about  two  thirds. 

What  is  cream? 

Cream  is  often  spoken  of  as  if  it  were  the  fat 
in  milk.  It  is  really  the  part  of  the  milk  which 
contains  most  of  the  fat.  It  differs  from  milk 
chiefly  in  containing  much  more  fat. 

In  what  ways  is  cream  now  obtained? 

(1)  By  skimming,  after  the  milk  has  stood  usu- 
ally for  twenty-four  hours ;  this  is  known  as  "  grav- 
ity cream."  (2)  By  an  apparatus  known  as  a  sepa- 
rator ;  this  is  known  as  "  centrifugal  cream  " ;  most 
of  the  cream  now  sold  in  cities  is  of  this  kind.  The 
richness  of  any  cream  is  indicated  by  the  amount  of 
fat  it  contains. 

The  usual  gravity  cream  sold  has  from  16  to  20 
per  cent  fat.  The  cream  removed  from  the  upper 
part  (one  fifth)  of  a  bottle  of  milk  has  about  16  per 
cent  fat.  The  usual  centrifugal  cream  has  18  to  20 
per  cent  fat.  The  heavy  centrifugal  cream  has  35 
to  40  per  cent  fat. 

7s  cream  more  digestible  than  milk? 
This    depends  much   upon   circumstances.      For 
most    infants    it    is    much    less    so;    many    seri- 


66         THE  CARE  AND  FEEDING  OF  CHILDREN 

ous     disturbances     of     digestion     are     caused     by 
cream. 


What  are  the  important  points  to  he  rememhered 
in  modifying  cow's  milk  for  feeding  during  the  early 
months? 

That  of  the  different  ingredients  the  sugar  is  most 
easily  digested;  for  most  infants  the  fat  is  next; 
while  the  proteids  are  the  most  difficult  of  all. 

There  are,  however,  some  infants  who  have  as 
much  difficulty  in  digesting  the  fat  as  they  do  in 
digesting  the  proteids  of  cow's  milk. 

What  relation  should  the  fat  hear  to  the  proteids 
during  this  period? 

For  most  infants  Avith  good  digestion  the  best 
results  are  obtained  when  the  fat  is  higher  than  the 
proteids — e.  g.,  twice  as  much.  However,  this  is  not 
true  of  all.  There  are  many  healthy  infants  who  are 
unable  to  digest  this  proportion  of  fat,  and  who  do 
much  better  when  the  fat  and  the  proteids  are  about 
equal. 

*  The  directions  and  formulas  given  in  the  following  pages  are 
intended  only  for  guidance  in  feeding  children  who  are  not  suf- 
fering from  any  special  disturbance  of  digestion;  directions  for 
such  conditions  are  given  in  a  later  chapter. 


FOOD  FOR  HEALTHY  INFANTS  67 

Two  groups  of  formulas  are  therefore  useful: 
(1)  Those  in  which  the  fats  are  higher  than  the 
proteids,  derived  from  top-milk;  (2)  those  in  which 
the  two  are  about  the  same,  derived  from  whole 
milk. 

How  can  one  ohtain  formulas  in  which  the  fat 
is  twice  the  proteids? 

Bj  using  for  dilution  a  Y-per-cent  milk,  for  in 
this  the  fat  is  exactly  twice  the  proteids. 

How  can  one  get  the  7-per-cent  milk? 

(1)  Most  easily  as  top-milk,  as  described  on  page 
64;  or  (2)  by  mixing  three  parts  of  milk  and  one 
part  of  ordinary  (16-per-cent)  cream;  (3)  from  any 
of  the  milk  laboratories  it  may  be  obtained  directly. 

How  should  the  food  he  prepared? 

It  is  convenient  in  calculation  to  make  up  twenty 
ounces  of  food  at  a  time.  The  first  step  is  to  obtain 
the  7-per-cent  milk.  Then  to  take  the  number  of 
ounces  of  this  that  are  called  for  in  the  formula 
desired. 

!N'oTE. — One  should  not  make  the  mistake  of 
taking  from  the  top  of  the  bottle  only  the  number 
of  ounces  needed  in  the  formula,  as  this  may  give 
quite  a  different  result. 

There  will  be  required  in  addition  one  ounce  of 


68    THE  CARE  AND  FEEDING  OF  CHILDREN 

milk  sugar  ^  and  one  ounce  of  lime-water  in  each 
tsventy  ounces.  The  rest  of  the  food  will  be  made 
up  of  boiled  water. 

These  formulas  written  out  would  be  as  follows: 


Formulas  from  7 

■per- 

cent  Milk 

I. 

II. 

III. 

IV. 

V. 

VI. 

VII. 

VIII. 

IX. 

7-per-cent  milk 

Milk  sugar 

Lime-water 

Boiled  water 

Oz. 
2 
1 

1 
17 

Oz. 
3 
1 

1 
16 

Oz. 

4 

1 

1 

15 

Oz. 

5 

1 

1 

14 

Oz. 

6 

1 

1 

13 

Oz. 
7 
1 
1 

12 

Oz. 

8 

1 

1 

11 

Oz. 

9 

1 

1 

10 

Oz. 
10 

1 
1 
9 

20 

20 

20 

20 

20 

20 

20 

20 

20 

The  approximate  composition  of  these  formulas 
expressed  in  percentages  is  as  follows: 


FoRMrLA. 

Fat. 

Sugar. 

Proteids. 

I        

0.70 
1.00 
1.40 
1.75 
2.00 
2.40 
2.80 
3.10 
'3.50 

5.50 
6.00 
6.00 
6.00 
6.50 
6.50 
6.50 
7.00 
7.00 

0  35 

II 

0.50 

Ill 

0.70 

IV 

0.87 

V 

1.00 

VI 

1.20 

VII               

1.40 

VIII    

1.55 

IX 

1.75 

^  If  the  milk  sugar  be  measured  in  the  milk-dipper,  two  scant 
■dipperfuls  may  be  calculated  as  one  ounce.  If  measured  in  a 
tablespoon,  three  even  tablespoonfuls  may  be  calculated  as  one 


FOOD  FOR  HEALTHY  INFANTS 


Why  is  it  necessary  to  make  the  food  so  weak 
at  first? 

Because  the  infant's  stomach  is  intended  to  digest 
breast  milk,  not  cow's  milk;  but  if  we  begin  with  a 
very  weak  cow's  milk  the  stomach  can  be  gradually 
trained  to  digest  it.  If  we  began  with  a  strong  milk 
the  digestion  might  be  seriously  upset. 

How  rapidly  can  the  food  he  increased  in  strength 
from  Formula  I  to  II,  from  II  to  III,  etc.  f 

1^0  absolute  rule  can  be  given.  Usually  we  begin 
w^ith  I  on  the  second  day ;  II  on  the  fourth  day ;  III 
at  ten  to  fourteen  days;  but  after  that  make  the 
increase  more  slowly.  A  large  infant  with  a  strong 
digestion  will  bear  a  rather  rapid  increase  and  may 
be  able  to  take  V  by  the  time  it  is  three  or  four 
weeks  old.  A  child  with  a  feeble  digestion  must  go 
much  slower  and  may  not  reach  V  before  it  is  three 
or  four  months  old. 

It  is  important  with  all  children  that  the  increase 
in  the  food  be  made  very  gradually.  It  may  be  best 
with  many  infants  to  increase  the  milk  by  only  half 
an  ounce  in  twenty  ounces  of  food,  instead  of  one 
ounce  at  a  time  as  indicated  in  the  tables.  Thus 
from  3  ounces,  the  increase  would  be  to  3^  ounces; 
from  4  ounces  to  4^  ounces,  etc.     At  least  two  or 


70         THE  CARE  AND  FEEDING   OP  CHILDREN 

three  days  should  be  allowed  between  each  increase 
in  the  strength  of  the  food. 

The  quantities  proper  for  the  different  ages,  and 
the  intervals  of  feeding,  are  given  on  page  105. 

What  general  rule  can  he  given  for  increasing  the 
food? 

To  increase  when  the  infant  is  not  satisfied  but  is 
digesting  well,  and  always  to  wait  at  least  two  or 
three  days  between  each  addition  to  the  food. 

For  fuller  directions  about  increasing  the  food  see 
pages  78  and  79. 

How  does  an  infant  show  that  he  is  not  satis- 
fied? 

He  drains  the  bottle  eagerly  and  cries  Avhen  it  is 
taken  away.  He  often  forms  the  habit  of  sucking 
his  fingers  immediately  after.  He  begins  to  fret 
half  an  hour  or  an  hour  before  the  next  feeding 
is  due. 

Under  such  circumstances  is  it  better  to  increase 
the  strength  or  the  quantity  of  the  food? 

It  is  well  to  alternate;  at  first  increasing  the 
strength,  next  the  quantity,  then  the  strength,  and 
so  on. 

Up  to  what  age  should  formulas  from  7-per-cent 
milk  he  continued? 

Usually  up  to  six  or  seven  months. 


FOOD   FOR  HEALTHY  INFANTS  71 


What  formulas  should  follow  these  ? 

The  change  should  gradually  be  made  to  those 
from  whole  milk. 


How  may  this  he  done  f 

Instead  of  removing  the  upper  16  ounces  as 
top  milk,  one  may  for  two  weeks  remove  the  upper 
18  ounces  as  top  milk.  For  the  next  two  weeks 
remove  the  upper  20  ounces  as  top  milk.  For  the 
next  two  weeks  remove  the  upper  24  ounces  as  top 
milk. 

After  this  the  bottle  may  be  shaken  up  and  the 
whole  milk  used. 

After  these  changes  should  the  -number  of  ounces 
of  milk  in  the  food  remain  the  same  ? 

Only  while  the  upper  18  ounces  are  used.  When 
the  upper  20  ounces  are  removed  as  top-milk,  each  20 
ounces  of  the  food  should  contain  11  ounces  of  this 
milk.  When  the  upper  24  ounces  are  removed, 
each  20  ounces  of  the  food  should  contain  12  ounces 
of  this  milk.  When  the  whole  milk  is  used,  each 
20  ounces  of  the  food  should  contain  13  ounces  of  the 
milk. 

These  formulas  written  out  in  full  would  be  as 
follows ; 


72 


THE  CARE  AND  FEEDING  OF  CHILDREN 


I. 

II. 

III. 

Top-milk 

Milk  sugar 

Lime-water 

Gruel 

1 
1 
0 
8 

Oz. 
/Upperl      .2 
124  0Z./--  ^^ 

1 
4 
3 

Oz. 
/Wholel      iQ 
Imilk    /••  1^ 

1 
6 

Water 

0 

20 

20 

20 

Usually  by  the  time  ^o.  II  is  reached  farina- 
ceous food  may  be  introduced  in  the  form  of  gruel, 
as  explained  on  page  82. 

How  long  may  No.  Ill  he  continued? 

If  conditions  have  been  such  that  the  schedule 
could  be  followed  this  formula  would  be  reached  at 
seven  or  eight  months. 

With  little  or  no  change  this  may  be  continued 
until  the  child  is  nearly  a  year  old,  the  amount  of 
food  given  at  each  feeding  being,  of  course,  gradually 
increased.    See  page  105. 

In  the  series  of  formulas  given  in  the  table  the 
quantities  are  mentioned  for  making  only  twenty 
ounces  of  food.  How  should  it  he  prepared  when 
m,ore  than  this  quantity  is  needed? 

It  is  equally  convenient  to  make  up  25  ounces, 
30  ounces,  35  ounces,  or  40  ounces  at  a  time. 


FOOD  FOR  HEALTHY  INFANTS  78 

To  make 

25  ounces  of  any  formula  add  one  quarter  more  of  each  ingredient. 

30      "  "  "         "    one  half 

35      "  "  "  "   three  quarters    " 

40      "  "  "         "   twice  as  much    "         "  " 

Thus,  25  ounces  of  Formula  I  would  be  obtained 
by  using  2J  ounces  of  milk,  1^  ounces  of  sugar  and 
lime-water,  21 J  ounces  of  water;  30  ounces  of  the 
same  would  require  3  ounces  of  milk,  IJ  ounces  of 
lime-water  and  sugar,  and  25^  ounces  of  water;  35 
ounces  would  require  3^  ounces  of  milk.  If  ounces 
of  lime-water  and  sugar,  and  29f  ounces  of  water. 
The  amount  of  water  need  not  be  calculated  in  any 
case,  but  after  measuring  carefully  the  other  ingre- 
dients enough  water  should  be  added  to  bring  the  total 
up  to  the  amount  required. 

Formulas  from  Whole  Milk 

Why  is  such  a  series  of  formulas  necessary  for 
young  infants? 

Not  all  children  can  take  as  high  fats  as  are  given 
in  formulas  derived  from  7-per-cent  milk. 

How  is  this  shown  f 

Sometimes  simply  by  the  fact  that  they  do  not 
thrive  properly.  Sometimes  by  marked  symptoms  of 
indigestion,  such  as  habitual  vomiting,  or  loose  bowels 


74         THE  CARE  AND   FEEDING  OF  CHILDREN 

with  green  stools,  or  constipation  with  dry  crumbly 
stools.  In  general  the  advice  may  be  given  that  if  a 
child  is  not  doing  well  upon  the  first  series  of  formu- 
las a  change  to  the  second  should  be  made. 

Are  there  any  disadvantages  in  using  this  group 
of  formulas? 

It  is  certainly  true  that  there  is  with  most  chil- 
dren a  greater  tendency  to  constipation  than  when  the 
formulas  from  top-milk  can  be  given.  It  is  also  true 
that  when  the  fat  is  made  low  the  gain  in  weight  is 
less.  Because  of  this  fact  other  things  must  be  intro- 
duced to  take  the  place  of  the  fat. 

What  elements  can  taJce  the  place  of  the  fat? 

Principally  the  carbohydrates — sugar  and  starch. 
More  sugar  should  be  given  and  starches  should  be 
introduced  earlier  than  when  higher  fats  are  used. 


Formulas  from  Whole  Milk  {If-per-cent  Fat) 


I. 

II. 

III. 

IV. 

V. 

VI. 

VII. 

VIII. 

IX. 

X. 

Milk 

Oz. 
4 

1 

1 

15 

0 

Oz. 
5 

1 

1 

14 

0 

Oz. 
6 

1 

1 

11 

2 

Oz. 

7 

1 
1 

8 
4 

Oz. 

8 
1 
1 
5 
6 

Oz. 

9 

i 
1 

4 
6 

Oz. 
10 

i 

1 

3 
6 

Oz. 
11 

1 

\ 

6 

Oz. 
12 

i 
1 
1 

6 

Oz. 
18 

Sugar 

Lime-water  . . 

W   :er 

(     .el 

1 
0 
6 

20 

20 

20 

20 

20 

20 

20 

20 

20 

20 

FOOD  FOR  HEALTHY  INFANTS 


75 


The  approximate  composition  of  these  formulas 
expressed  in  percentages  is  as  follows: 


Formula, 

Fat. 

Sugar. 

Proteids. 

I 

0.80 
1.00 
1.20 
1.40 
1.60 
1.80 
2.00 
2.20 
2.40 
2.60 

6.00 
6.00 
6.00 
6.50 
6.50 
6.00 
6.00 
6.00 
6.00 
6.00 

0.70 

II 

0.90 

Ill               

1   00 

IV 

1.20 

V 

1.40 

VI 

1.60 

VII 

1.80 

VIII 

2.00 

IX 

2.10 

X 

2.30 

Gruel  for  Formulas  III,  IV,  and  V  should  be 
made,  one  level  tablespoonful  of  wheat,  barley  or  oat 
flour  to  8  ounces  of  water. 

For  formulas  VI,  VII,  VIII,  IX,  and  X,  two 
level  tablespoonfuls  to  8  ounces  of  water  should  be 
used. 

It  will  be  noted  that  N^o.  X  of  this  series  is  the 
same  as  No.  Ill,  page  72. 

How  should  the  food  he  made  up  if  these  formulas 
are  used? 

The  gruel  is  cooked  separately  as  described  on 
page  147 ;  when  it  has  partly  cooled  the  milk,  lime- 
water,  milk  sugar  and  water  are  added  and  thoroughly 
mixed. 


76         THE  CARE  AND  FEEDING  OP  CHILDREN 

How  should  the  strength  of  the  food  he  increased 
when  this  series  of  formulas  is  used  f 

The  general  rules  given  on  pages  70  and  Yl  may 
be  followed,  except  that  on  account  of  the  higher  pro- 
teids  in  this  series  the  increase  after  Xo.  Ill  should 
be  made  more  slowly ;  so  that  ordinarily  ~Eo.  V  would 
not  be  reached  until  about  two  months. 

How  rapidly  after  this  time  should  the  food  he 
strengthened? 

In  general  the  advance  from  one  formula  to  the 
next  stronger  should  be  made  once  a  month.  It  is 
often  desirable  to  make  half  the  increase  in  the  mid- 
dle of  the  month. 

If  the  schedule  is  followed  ^o.  X  would  be 
reached  at  seven  or  eight  months  and  may  be  con- 
tinued for  the  balance  of  the  first  year. 


GENERAL   EULES   FOE  GUIDANCE   IN   THE   USE   OF   THE 
FOEMULAS    GIVEN 

It  should  again  be  emphasized  that  these  for- 
mulas are  not  intended  for  sick  children  nor  for 
those  suffering  from  any  marked  symptoms  of  in- 
digestion. For  such  infants  special  rules  are  given 
later. 


GENERAL  RULES  FOR  GUIDANCE  77 

What  should  he  the  guide  in  deciding  upon  a 
formula  with  which  to  begin  for  a  child  who  is  to  he 
artificially  fed? 

The  age  and  the  weight  are  of  some  importance, 
but  the  best  guide  is  the  condition  of  the  child's 
digestive  organs.  One  should  always  begin  with  a 
weak  formula,  particularly,  (1)  with  an  infant  pre- 
viously breast  fed;  (2)  with  one  just  weaned,  as  a 
child  who  has  never  had  cow's  milk  must  at  first 
have  weaker  proportions  than  the  age  and  the  weight 
would  seem  to  indicate;  (3)  with  infants  whose  pow- 
er of  digestion  is  unknown.  If  the  first  formula 
tried  is  weaker  than  the  child  can  digest,  the  food 
can  be  strengthened  every  three  or  four  days  until 
it  is  found  what  the  child  is  able  to  take.  On  the 
contrary,  if  the  food  is  made  too  strong  at  first,  an 
attack  of  indigestion  will  probably  follow. 

How  should  the  food  he  increased  in  strength? 

The  first  essential  is  that  it  be  done  very  gradu- 
ally; abruptly  increasing  the  food  usually  causes  a 
disturbance  of  digestion. 

It  is  never  wise  to  advance  more  rapidly  in 
strengthening  the  food  than  from  one  formula  to  the 
next  one  in  any  of  lihe  series  given;  with  many  in- 
fants it  is  better  to  make  the  steps  of  increase  only 
half  as  great  as  those  indicated  (page  69). 


78         THE  CARE  AND  FEEDING  OF  CHILDREN 

How  rapidly  should  the  food  he  increased  in 
quantity? 

The  increase  should  not  be  more  than  a  quarter  of 
an  ounce  in  each  feeding ;  and  not  of tener  than  every 
three  days. 

When  should  the  food  he  increased? 

In  the  early  weeks  an  increase  may  be  necessary 
every  few  days;  in  the  later  months  sometimes  the 
same  formula  may  be  continued  for  two  or  three 
months.  It  is,  however,  impossible  to  give  a  definite 
rule  as  to  time.  One  cannot  say  with  any  child  that 
an  increase  is  to  be  made  every  week  or  every  two 
weeks.  A  much  better  guide  is  the  condition  of  the 
digestion  as  shown  by  the  child's  appetite.  The  char- 
acter of  the  stools,  the  sleep,  and  the  general  disposi- 
tion. 

The  signs  indicating  that  the  food  should  be  in- 
creased are,  that  the  infant  is  not  satisfied,  not  gain- 
ing in  weight,  but  is  digesting  well,  i.  e.,  not  vomit- 
ing, and  having  good  stools.  One  should  not  increase 
the  food,  however,  so  long  as  the  child  seems  perfectly 
satisfied  and  is  gaining  from  four  to  six  ounces  a 
week,  even  though  both  the  quantity  and  the  strength 
of  the  food  are  considerably  below  the  average ;  nor 
should  the  food  be  increased  if  the  child  is  gaining 
from  eight  to  ten  ounces  a  week,  even  if  he  seems 


GENERAL   RULES  FOR  GUIDANCE  79 


somewhat  hungry.  The  appetite  is  not  always  a  safe 
guide  to  follow.  There  are  many  infants  who  will 
habitually  take  more  food  than  they  are  able  to  digest 
and  there  is  a  danger  of  increasing  the  amount  of  food 
beyond  the  normal  capacity  of  the  child's  stomach. 
The  ultimate  results  of  such  overfeeding  are  serious 
disturbances  of  digestion  and  in  some  instances  dila- 
tation of  the  stomach. 

How  can  one  Jcnoiv  whether  the  strength  or  the 
quantity  of  the  food  should  he  increased? 

In  the  early  weeks  it  is  well  first  to  increase 
the  strength  of  the  food,  the  next  time  to  increase 
the  quantity,  then  the  strength  again,  etc.  After  the 
fourth  or  fifth  month,  the  quantity,  chiefly,  should 
be  increased. 

//  a  slight  disturbance  or  discomfort  occurs  after 
the  food  has  been  strengthened,  is  it  best  to  go  bach 
to  the  weaker  formula  or  to  persist  with  the  new  one  ? 

Symptoms  of  minor  discomfort  are  seen  for  a  day 
or  two  with  many  infants  after  an  ordinary  increase 
in  food;  but  in  most  cases  an  infant  soon  becomes 
accustomed  to  the  stronger  food  and  is  able  to  digest 
it.  If,  however,  the  symptoms  of  disturbance  are 
marked,  one  should  promptly  go  back  to  the  weaker 
formula.    The  next  increase  should  be  a  smaller  one. 


80         THE  CARE  AND  FEEDING  OF  CHILDREN 

Should  one  he  distuTJjed  if  for  the  first  two  or 
three  weeks  of  artificial  feeding  the  gain  in  weight 
is  very  slight  or  even  if  there  is  none  ? 

'Not  as  a  rule.  If  the  infant  does  not  lose 
weight,  is  perfectly  comfortable,  sleeps  most  of  the 
time,  and  does  not  suffer  from  any  symptoms  of  indi- 
gestion, such  as  colic,  vomiting,  etc.,  one  may  be  sure 
that  all  is  going  well  and  that  the  infant  is  becoming 
used  to  his  new  food.  As  the  child's  appetite  im- 
proves and  his  digestion  is  stronger,  the  food  may  be 
increased  every  few  days  and  very  soon  the  gain  in 
weight  will  come  and  will  then  be  continuous.  If, 
however,  the  scales"  are  watched  too  closely  and,  be- 
cause there  is  only  a  slight  gain  in  weight  or  none 
at  all,  the  food  is  rapidly  increased,  an  acute  dis- 
turbance of  digestion  is  pretty  certain  to  follow. 

7s  not  constipation  likely  to  occur  if  the  child  is 
on  a  very  weak  food? 

It  is  very  often  seen  and  is  due  simply  to  the 
small  amount  of  residue  in  the  intestine.  But  if  the 
bowels  move  once  a  day,  one  should  not  be  disturbed 
even  when  the  movements  are  small  and  somewhat  dry. 
As  the  food  is  gradually  strengthened,  this  constipation 
soon  passes  off;  while  if  injections,  suppositories,  or 
cathartics  are  used  to  produce  freer  movements,  the 
functions  of  the  bowels  are  likely  to  be  disturbed. 


FOR  GUIDANCE  81 


Under  what  circumstances  should  the  food  he 
reduced? 

Whenever  the  child  becomes  ill  from  any  cause 
whatever,  or  whenever  any  marked  symptoms  of  indi- 
gestion arise. 

How  may  this  he  done  ? 

If  the  disturbance  is  only  a  moderate  one  and  the 
food  has  been  made  up  for  the  day,  one  third  may  be 
poured  off  from  the  top  of  each  bottle  just  before  it 
is  given,  and  this  quantity  of  food  replaced  by  the 
same  amount  of  boiled  water. 

If  the  disturbance  is  more  severe,  the  food 
should  be  immediately  diluted  by  at  least  one  half 
and  at  the  same  time  the  quantity  given  should  be 
reduced. 

For  a  severe  acute  attack  of  indigestion  the  regu- 
lar food  should  be  omitted  altogether  and  only  water 
given  until  the  doctor  has  been  called. 

If  the  food  has  heen  reduced  for  a  disturhance 
of  digestion,  how  should  one  return  to  the  original 
formula  f 

While  the  reduction  of  the  food  should  be  im- 
mediate and  considerable,  the  increase  should  be  very 
gradual.  After  a  serious  attack  of  acute  indigestion, 
when  beginning  with  milk  again,  it  should  not  be 


82    THE  CARE  AND  FEEDING  OP  CHILDREN 

made  more  than  one  fifth  the  original  strength,  and 
from  ten  days  to  two  weeks  should  pass  before  the 
child  is  brought  back  to  his  original  food,  which 
should  be  done  very  gradually.  It  is  surprising  how 
long  a  time  is  required  with  young  infants  before 
they  completely  recover  from  an  attack  of  acute  indi- 
gestion, even  though  it  did  not  seem  to  be  very  severe. 
The  second  disturbance  always  comes  from  a  slighter 
cause  than  the  first  one. 

THE  ADDITION  OF  OTHEE  FOODS  TO  MILK 

When  should  other  food  he  added  to  the  milk? 

This  depends  upon  circumstances.  If  formulas 
from  7-per-cent  milk  are  given,  farinaceous  food  is 
usually  begun  at  six  or  seven  months.  If  formulas 
from  whole  milk  are  used  it  may  be  given  earlier ;  a 
small  amount  may  be  added  as  early  as  two  months, 
and  at  three  months  more  may  be  given.  The  reason 
for  this  has  already  been  mentioned  (page  74). 

What  further  additions  may  he  made  to  the  diet 
of  healthy  infants  during  the  first  year? 

Beef  juice,  the  white  of  egg,  and  orange  juice. 

How  and  when  may  heef  juice  he  used? 
With  infants  who  are  strong  and  thriving  satis- 
factorily it  may  be  begun  at  ten  or  eleven  months; 


THE  ADDITION"  OF  OTHER  FOODS  TO  MILK      83 

two  teaspoonfuls  may  be  given  daily,  diluted  with 
the  same  quantity  of  water,  fifteen  minutes  before 
the  midday  feeding;  in  two  weeks  the  quantity 
may  be  doubled;  and  in  four  weeks  six  teaspoon- 
fuls  may  be  given.  The  maximum  quantity  at  one 
year  should  not  be  more  than  two  or  three  table- 
spoonfuls. 

With  delicate  infants  who  are  pale  and  ana?mic, 
beef  juice  is  more  important,  and  it  may  often  be 
wisely  begun  at  five  or  six  months  in  half  the  quan- 
tities mentioned. 

When  should  white  of  egg  he  used? 

Under  the  same  conditions  as  beef  juice,  particu- 
larly with  infants  who  have  difficulty  in  digesting 
the  proteids  (curd)  of  milk.  At  six  months  half 
the  white  of  one  egg  may  be  given  at  one  time,  and 
soon  after  this  the  entire  white  of  one  egg.  The  best 
manner  of  cooking  is  the  "  coddled  "  Qgg  (see  page 
149). 

When  should  orange  juice  he  hegun  ? 

There  are  many  infants  whose  nutrition  is  dis- 
tinctly benefited  by  giving  small  quantities  of  orange 
juice  as  early  as  five  or  six  months,  when  two  or  three 
teaspoonfuls  a  day  may  be  given  an  hour  before  the 
feeding.     By  the  time  one  year  is  reached  from  two 


84    THE  CARE  AND  FEEDING  OF  CHILDREN 

to  four  tablespoonfuls  a  ^ay  may  be  given.  It  is  par- 
ticularly useful  when  there  is  constipation.  It  should 
always  be  strained,  and  care  should  be  taken  that  it  is 
sweet  and  fresh. 

OVERFEEDING 

What  is  meant  hy  overfeeding? 

Giving  an  infant  too  much  food ;  either  too  much 
at  one  time  or  too  frequently.  Overfeeding  is  some- 
times practised  during  the  day,  but  is  chiefly  done 
at  night. 

7s  not  an  infant's  natural  desire  for  food  a  proper 
guide  as  to  the  qvxintity  given  f 

The  appetite  of  a  perfectly  normal  infant  usu- 
ally is ;  but  overeating  is  a  habit  gradually  acquired 
and  may  continue  until  twice  as  much  food  as  is 
proper  is  taken  in  the  twenty-four  hours.  This  habit 
is  most  frequently  seen  in  infants  whose  digestion 
is  not  quite  normal ;  because  of  the  temporary  relief 
from  discomfort  experienced  by  taking  food  into  the 
stomach,  they  often  appear  to  be  hungry  the  greater 
part  of  the  time,  especially  at  night. 

What  are  the  causes  of  overfeeding? 
The  most  common  one  is  the  habit  of  watching 
the  weight  too  closely,  and  the  conviction  on  the  part 


OVERFEEDING  85 


of  the  mother  or  nurse  that  because  a  child  is  not  so 
large  nor  gaining  so  rapidly  as  some  other  infant 
of  the  same  age,  more  food  or  stronger  food  should 
be  given. 

What  harm  results  from  overfeeding? 

All  food  taken  in  excess  of  what  a  child  can  digest 
becomes  a  burden  to  him.  The  food  lies  in  the 
stomach  or  bowels  undigested,  ferments,  and  causes 
wind  and  colic.  When  overfeeding  is  longer  con- 
tinued, serious  disturbances  of  digestion  are  soon 
produced.  The  infant  is  restless,  fretful,  constantly 
uncomfortable,  sleeps  badly,  and  stops  gaining  and 
may  even  lose  in  weight.  Such  symptoms  may 
lead  to  the  mistaken  conclusion  that  too  little  food 
is  given,  and  it  is  accordingly  increased,  when  it 
should  be  diminished.  One  of  the  results  of  long- 
continued  overfeeding  is  dilatation  or  stretching  of 
the  stomach. 

What  should  guide  one  as  to  the  quantity  of  food 
to  he  given  to  any  infant? 

(1)  The  size  of  the  infant's  stomach  at  the  dif- 
ferent months;  (2)  the  amount  of  milk  which  the 
healthy  nursing  infant  gets;  (3)  the  quantities  with 
which  most  children  do  best.  The  table  of  quantities 
and  intervals  of  feeding,  on  page  105,  gives  the  aver- 


86         THE  CARE  AND  FEEDING   OF  CHILDREN 

age  figures  derived  f rom.''these  sources.  It  is  seldom 
wise  to  go  beyond  the  limits  there  stated ;  nor  should 
one  insist  upon  giving  any  fixed  amount  if  it  is 
clearly  more  than  the  child  wants  or  can  be  made  to 
take  except  by  continued  coaxing. 

LOSS    OF    APPETITE 

What  is  to  he  done  when  without  any  other  signs 
of  illness  a  child's  appetite  gradually  fails? 

This  is  often  the  result  of  a  long  period  of  over- 
feeding or  the  use  of  milk  too  rich  in  fat.  If  in  all 
other  respects  the  chil(J  seems  well  and  simply  does 
not  want  his  food,  it  should  be  offered  at  regular 
hours,  but  not  more  frequently ;  on  no  account  should 
he  be  coaxed,  -much  less  forced,  to  eat,  even  though  he 
takes  only  one  half  or  one  third  the  usual  quantity. 
The  intervals  between  feedings  should  not  be  short- 
ened but  rather  lengthened.  Often,  with  a  child  a 
year  old,  it  is  necessary  to  reduce  the  number  of 
feedings  to  four  or  even  three  in  twenty-four  hours. 
Water,  however,  may  be  offered  at  more  frequent  in- 
tervals. The  food  should  be  weakened  rather  than 
strengthened.  !N'o  greater  mistake  can  be  made  than, 
because  so  little  is  taken,  coaxing  or  forcing  food  at 
short  intervals  through  fear  lest  the  child  may  lose 
weight. 


CHANGES  REQUIRED  BY  SPECIAL  SYMPTOMS    87 


THE    CHANGES    IN    THE    FOOD    EEQUIEED    BY    SPECIAL 
SYMPTOMS    OR    CONDITIONS 

Why  is  it  that  an  infant  so  often  vomits  some 
of  its  food  within  a  few  moments  after  finishing  its 
bottle  f 

Usually  because  the  quantity  is  too  large.  Some- 
times it  is  due  to  the  fact  that  the  food  is  taken  too 
rapidly,  from  too  large  a  hole  in  the  nipple.  It 
may  he  due  to  too  tight  clothing,  or  to  moving  the 
child  about  in  such  a  way  as  to  press  upon  the 
stomach. 

What  are  the  principal  causes  of,  and  the  changes 
in  the  food  required  hy  habitual  vomiting,  regurgi- 
tation, or  spitting  up  of  small  quantities  of  food 
between  feedings,  often  repeated  many  times  a 
day? 

This  is  a  symptom  of  gastric  indigestion,  and  a 
most  troublesome  one.  In  such  conditions  the  fat 
should  always  be  reduced  and  the  lime-water  may  be 
increased. 

In  cases  not  improved  by  this  change  it  may  be 
necessary  to  reduce  the  fat  still  further.  This  is 
especially  true  if  the  whole  milk  used  is  very  rich. 


88         THE  CARE  AND  FEEDING  OF  CHILDREN 

Under  these  circumstances  one  should  remove  some 
of  the  cream  from  the  top  of  the  bottle  before  shak- 
ing it  up. 

How  much  cream  should  he  removed? 

At  first  4  ounces  may  be  taken  off,  after  which 
the  bottle  is  shaken  and  the  balance  used  as  in  the 
formulas  from  whole  milk.  After  a  few  days  if 
the  sjTnptoms  improve  only  3  ounces  of  cream  may 
be  removed.  After  a  few  days  longer  only  2  ounces 
are  removed,  then  only  1  ounce  and  finally  the 
child  is  brought  back  to  the  mixtures  from  whole 
milk. 

How  much  lime-water  may  he  used? 

Improvement  from  this  change  may  follow  if  the 
amount  of  lime-water  is  doubled.  There  is  rarely 
any  advantage  in  using  more  than  this ; — i.  e.,  2 
ounces  in  20  ounces  of  food. 

7s  vomiting  often  increased  hy  the  sugar? 

This  is  not  likely  with  milk  sugar  if  only  the 
quantity  mentioned  in  the  formulas  is  used.  How- 
ever the  use  of  cane  sugar  often  aggravates  the  vomit- 
ing, and  malt  sugar  almost  invariably  does  so.  There- 
fore under  these  conditions  the  use  of  any  of  the 
malted  foods  should  be  carefully  avoided. 


CHANGES  REQUIRED  BY  SPECIAL  SYMPTOMS    89 

What  changes  should  he  made  in  the  intervals  of 
feeding  ? 

Under  no  circumstances  should  a  vomiting  baby 
be  fed  oftener  than  every  three  hours,  and  sometimes 
the  intervals  should  be  longer. 

What  changes  should  he  made  in  the  quantity 
given  at  a  feeding? 

It  is  difficult  to  lay  down  an  absolute  rule.  Usu- 
ally a  small  quantity  of  a  stronger  food  is  better  than 
a  larger  quantity  of  a  weak  food.  But  one  should 
not  give  more  than  is  advised  in  the  schedule  for  the 
age  of  the  child.  To  give  somewhat  smaller  quanti- 
ties is  sometimes  useful  but  often  this  is  of  no  assist- 
ance. 

What  are  the  causes  of,  and  food  changes  required 
hy  a  constant  and  excessive  formation  of  gas  in  the 
stomach,  leading  to  distention  and  pain^  or  eructa- 
tions (helching)  of  gas  and  often  of  a  sour,  watery 
fluid? 

This  is  often  associated  with  habitual  vomiting, 
and  is  due  to  similar  causes,  but  particularly  to  the 
sugars  mentioned. 

Besides  the  measures  already  described  to  con- 
trol vomiting,  benefit  sometimes  follows  the  use  of 
benzoate  of  soda,  of  which  half  a  grain  may  be  added 


90         THE  CARE  AND  FEEDING   OF  CHILDREN 

to  each  ounce  of  food  and  continued  for  a  few  weeks 
if  necessary. 

What  changes  should  he  made  in  the  food  when 
there  is  habitual  flatulence  and  colic? 

Flatulence  occurs  when  there  is  excessive  forma- 
tion of  gas  in  the  intestines.  If  this  is  readily  ex- 
pelled the  child  suffers  no  great  discomfort;  but  if 
not,  some  distention  of  the  bowel  takes  place  and  colic 
results. 

Both  these  conditions  are  greatly  aggravated  by 
constipation,  and  to  relieve  the  constipation  is  often 
the  best  means  of  controlling  them. 

The  gas  usually  arises  from  faulty  digestion  of 
the  sugars,  starch  or  proteids,  and  any  of  these  ele- 
ments of  the  food  may  need  to  be  reduced,  particu- 
larly the  starch  which  in  many  cases  should  be 
omitted  altogether. 

If  the  proteids  are  at  fault  benefit  may  follow 
the  use  of  partially  peptonized  milk. 

What  changes  should  he  made  in  the  food  for 
chronic  constipation  ? 

Nothing  should  be  done  if  the  child  has  one  good 
movement  a  day.  Such  a  child  cannot  be  called  con- 
stipated. 

The  constipation  of  the  first  weeks  of  life  has 


CHANGES  REQUIRED  BY  SPECIAL  SYMPTOMS     91 

been  already  referred  to  (page  80)  ;  it  usually  dis- 
appears as  the  food  is  gradually  strengthened  in  all 
its  proportions. 

Habitual  constipation  at  a  later  period  is  dijfficult 
to  overcome  by  diet  alone.  It  sometimes  depends 
upon  the  fact  that  the  proteids  are  too  high,  and 
sometimes  that  the  fat  is  too  low.  Hence  it  is  more 
frequent  when  infants  are  fed  upon  formulas  from 
whole  milk,  than  when  formulas  from  top-milk,  or 
milk  and  cream  are  used.  But  it  is  not  desirable 
to  use  a  top-milk  containing  more  than  7-per-cent  fat 
for  this  purpose  as  other  disturbances  of  digestion 
may  be  produced.  i^ 

In  some  cases  a  part  or  all  of  the  milk  sugar  may 
be  replaced  by  malt  sugar  (maltose).  This  may  be 
used  in  the  form  of  Trommer's  extract  of  malt,  Bor- 
cherdf  s  or  Loeflund's  malt  soup  extract.  Of  these 
from  one  teaspoonful  to  one  ounce  may  be  added  to 
the  food  when  it  is  made  up  for  the  day.  Or  some 
of  the  foods  which  contain  a  large  amount  of  malt- 
ose (Mellin's  food,  malted  milk,  cereal  milk)  may 
replace  the  milk  sugar. 

The  substitution  of  the  milk  of  magnesia  for  the 
lime-water  as  recommended  on  page  60  will  often  be 
found  useful.  After  a  short  time  the  amount  given 
each  day  may  gradually  be  reduced  until  finally  it  is 
discontinued. 


92         THE  CARE  AND  FEEDING  OF  CHILDREN 

To  infants  over  nme>  months  old,  orange  juice 
may  be  given. 

What  special  modifications  are  required  during 
very  hot  weather? 

During  the  warm  season  it  is  well  to  make  the 
proportion  of  fat  less  than  during  cold  weather. 
During  short  periods  of  excessive  heat  it  should 
be  much  less.  The  fat  is  reduced  by  using  whole 
milk  in  place  of  the  7-per-cent  milk.  At  such 
times  also  the  usual  food  should  be  diluted, 
and  water  should  be  given  freely  between  the 
feedings. 

What  changes  should  he  made  in  the  food  of  a 
child  who,  with  all  the  signs  of  good  digestion,  gains 
very  little  or  not  at  all  in  weight? 

If  the  child  seems  hungry  the  quantity  of  food 
may  be  increased;  but  if  the  child  will  not  readily 
take  any  more  in  quantity  the  strength  may  be  in- 
creased by  the  use  of  the  next  higher  formula.  (If 
there  is  no  vomiting  the  addition  of  one  of  the  prep- 
arations of  malt  as  recommended  for  the  relief  of 
constipation  may  be  useful.)  One  should,  however, 
be  extremely  careful  under  these  circumstances  not 
to    coax   or    force    a    child    to    eat;    for    this    plan 


CHANGES  REQUIRED  BY  SPECIAL  SYMPTOMS     93 

is  almost  certain  to  cause  disturbance  of  digestion  and 
actual  loss  in  weight.  A  better  policy  is  that  of 
looking  after  the  other  factors  in  the  child's  life, — 
the  care,  sleep,  fresh  air,  etc.,  for  with  these  rather 
than  with  the  food  the  trouble  often  lies. 

What  should  he  done  with  infants  who  in  spite 
of  all  variations  in  the  milk  continue  to  have  symp- 
toms of  indigestion  and  do  not  thrive? 

Except  inmates  of  institutions  who  form  a  class 
by  themselves,  most  infants  who  receive  proper  care 
thrive  upon  milk  if  the  proportions  suited  to  the 
digestion  are  given.  Still  there  are  some  who  do  not. 
The  nutrition  of  such  is  always  a  matter  of  difficulty. 

If  a  wet-nurse  is  available  the  employment  of  one 
is  the  thing  most  likely  to  succeed,  particularly  if  the 
infant  is  under  four  or  five  months  old. 

If  the  infant  is  older,  or  if  a  wet-nurse  cannot  be 
obtained,  some  of  the  substitutes  for  fresh  cow's  milk 
may  be  tried.  One  of  the  best  is  condensed  milk, 
Borden's  Eagle  brand,  canned,  being  preferred.  This 
is  more  likely  to  agree  if  the  symptoms  are  chiefly 
intestinal  (colic,  flatulence,  curds  in  the  stools,  con- 
stipation or  diarrhoea)  than  if  they  are  chiefly  gas- 
tric (vomiting,  regurgitation,  etc.). 

How  should  condensed  milk  he  usedf 

Eor  an  infant  three   or   four  months   old   with 


94         THE  CARE  AND  FEEDING   OF  CHILDREN 

symptoms  of  indigestion^  it  should  at  first  be  di- 
luted with  16  parts  of  boiled  water,  or,  sometimes 
preferably,  with  barley-water.  With  improvement 
in  the^  symptoms  the  dilution  may  be  made  1  to  14, 
1  to  12,  1  to  10,  and  1  to  8,  these  changes  being 
gradually  made.  The  intervals  between  feedings 
and  the  quantities  for  one  feeding  are  given  on 
page  108. 

How  long  should  condensed  milk  he  continued? 

In  most  cases  it  should  be  used  as  the  sole  food 
for  a  few  weeks  only.  Afterward,  one  feeding  a  day 
of  a  weak  formula  of  modified  milk  (e.  g.,  ^N'o.  II  or 
III  Whole  Milk  Series,  page  74  may  be  given; 
later  two  feedings,  and  thus  gradually  the  number 
of  milk  feedings  is  increased  until  the  child  is  tak- 
ing only  modified  milk. 

Condensed  milk  is  not  to  be  recommended  as  a 
permanent  food  where  good  fresh  cow's  milk  can  be 
obtaiDed. 

What  are  the  objections  to  its  ttse? 

It  is  very  low  in  fat  and  proteids,  and  high  in 
sugar.  This  accounts  for  its  easy  digestibility,  and 
also  explains  why  children  reared  upon  it  often  gain 
very  rapidly  in  w^eight,  yet  have  as  a  rule  but  little 
resistance.  They  are  very  prone  to  develop  rickets 
and  sometimes  scurvy. 


CHANGES  REQUIRED  BY  SPECIAL  SYMPTOMS     95 

Are  the  proprietary  infant  foods  open  to  the  same 
objections  as  condensed  milk? 

They  are.  What  has  been  said  of  condensed  milk 
applies  equally  well  to  most  of  those  that  are  sold  in 
the  market  as  substitutes  for  milk. 

What  changes  in  the  food  are  required  by  slight 
indisposition  ? 

For  slight  general  disturbances  such  as  dentition, 
colds,  sore  throats,  etc.,  it  is  usually  sufficient  simply 
to  dilute  the  food.  If  this  is  but  for  two  or  three 
feedings,  it  is  most  easily  done  by  replacing  with 
boiled  water  an  ounce  or  two  of  the  food  removed 
from  the  bottle  just  before  it  is  given ;  if  for  several 
days,  a  weaker  formula  should  be  used. 

What  changes  should  be  made  for  a  serious  acute 
illness? 

For  such  attacks  as  those  of  pneumonia,  bron- 
chitis, measles,  etc.,  attended  with  fever,  the  food 
should  be  diluted  and  the  fat  reduced  as  described 
on  page  92.  It  should  be  given  at  regular  intervals, 
rather  less  frequently  than  in  health.  Water  should 
be  given  freely  between  the  feedings.  Food  should 
not  be  forced  in  the  early  days  of  an  acute  illness, 
since  the  loss  of  appetite  usually  means  an  inability 
to  digest  much  food. 


96         THE  CARE  AND  FEEDING   OF  CHILDREN 

What  immediate  changes  should  he  made  in  the 
food  when  the  child  has  an  acute  attack  of  gastric  in- 
digestion with  repeated  vomiting ,  fever,  pain,  etc.  f 

All  milk  should  be  stopped  at  once,  and  only 
boiled  water  given  for  ten  or  twelve  hours;  after- 
ward barlej-water  or  whey  may  be  tried,  but  no 
milk  for  at  least  twenty-four  hours  after  the  vom- 
iting has  ceased.  When  beginning  with  modified 
milk,  formulas  made  from  skimmed  milk  as  described 
on  page  88  should  be  used  for  a  few  days.  The  pro- 
portion of  lime-water  may  be  doubled. 

What  changes  should  he  made  for  an  attack  of  in- 
testinal indigestion  with  looseness  of  the  bowels? 

If  this  is  not  severe  (only  two  or  three  passages 
daily)  the  fat  should  be  lowered  in  the  manner 
stated  just  above,  and  the  milk  should  be  boiled  for 
five  minutes.  If  undigested  milk  appears  in  the 
stools,  it  may  be  still  further  diluted.  If  the  diar- 
rhoeal  attack  is  more  severe,  and  attended  by  fever 
and  foul-smelling  movements  of  greater  frequency,  all 
milk  should  be  stopped  immediately,  and  the  diet 
mentioned  just  above  under  the  head  of  acute  dis- 
turbances of  the  stomach  should  be  employed. 

What  changes  in  the  food  should  be  made  when 
the  child  seems  to  have  very  little  appetite  and  yet 
is  not  ill? 


CHANGES  EEQUIRED  BY  SPECIAL  SYMPTOMS    97 

The  number  of  feedings  should  be  reduced,  the 
interval  being  lengthened  by  one  hour  or  even  more. 
'No  greater  mistake  can  be  made  than  to  offer  food 
every  hour  or  two  to  an  infant  who  is  not  hungry. 
That  only  prolongs  and  aggravates  the  disturbance. 

What  other  conditions  besides  the  food  greatly 
influence  the  child's  digestion? 

Proper  clothing,  warm  feet,  regular  habits,  fresh 
air,  clean  bottles,  and  food  given  at  the  proper  tem- 
perature, are  all  quite  as  important  as  the  prepara- 
tion of  the  food ;  quiet,  peaceful  surroundings  and 
absence  of  excitement  are  also  essential  to  good  di- 
gestion. In  many  cases  in  which  children  suffer  fre- 
quently from  indigestion  and  do  not  gain  properly  in 
weight,  the  fault  is  not  with  the  food  but  with  the 
care  that  the  child  receives.  Both  while  the  food  is 
being  taken  and  afterwards  he  should  be  left  quite 
alone.  This  is  particularly  necessary  with  nervous 
children. 

COMMON    MISTAKES    11^    MILK    MODIFICATION    AND 
INFANT    FEEDING 

I.  In  using  modifications  made  from  top-milk, 
much  confusion  arises  from  the  notion  that  top-milk 
is  a  single  definite  thing,  whereas  its  composition 
depends  upon  a  great  variety  of  conditions  and,  un- 


98         THE  CARE  AND  FEEDING  OF  CHILDREN 

less  all  these  are  known, 'it  is  impossible  to  tell  how 
strong  it  is.  Directions  for  the  removal  of  top-milk 
should  be  explicitly  followed,  or  the  results  wall  be 
Terj  different  from  those  expected. 

II.  In  formulas  calling  for  a  certain  number  of 
ounces  of  top-milk,  the  mistake  is  made  of  removing 
only  the  number  of  ounces  needed  for  the  formula. 
The  proper  way  is  to  remove  the  amount  required  to 
secure  a  top-milk  of  the  desired  strength  and  then  to 
take  of  this  the  number  of  ounces  needed  in  the 
formula. 

III.  A  rich  Jersey  milk  is  used  as  if  it  were 
ordinary  milk.  The  formulas  given  in  this  book  are 
chiefly  calculated  on  the  basis  of  a  good  average  milk 
w^hich  contains  about  4  per  cent  fat.  Many  persons 
have  the  idea  that  the  richer  the  milk,  the  more  rap- 
idly the  child  will  gain  in  weight,  and  hence  the 
superiority  of  such  milk  for  infant  feeding.  While 
it  is  true  that  some  children  taking  a  very  rich  milk 
may,  for  a  time,  gain  rapidly  in  weight,  yet  sooner 
or  later,  serious  disturbances  of  digestion  are  nearly 
always  produced. 

IV.  The  food  is  increased  too  rapidly,  particu- 
larly after  some  disturbance  of  digestion.  If,  in  an 
infant  three  or  four  months  old,  an  attack  of  some- 
what acute  indigestion  occurs,  the  food  should  sel- 
dom be  given  in  full  strength  before  two  weeks.     The 


PREPARATION  OF  COW'S  MILK  AT  HOME        99 

increase  in  the  diet  should  be  made  very  gradually, 
the  steps  being  made  only  one  half  those  indicated  in 
the  series  of  formulas  found  on  page  68.  Other- 
wise it  generally  happens  that  the  attack  of  indiges- 
tion is  very  much  prolonged  and  much  loss  in  weight 
occurs. 

V.  When  symptoms  of  indigestion  occur,  the  food 
is  not  reduced  rapidly  enough.  Indigestion  usually 
means  that  the  organs  are,  for  the  time,  unequal  to 
the  work  imposed.  If  the  food  is  immediately  re- 
duced by  one  half,  the  organs  of  digestion  soon  regain 
their  power  and  the  disturbance  is  short.  In  every 
case  the  amount  of  reduction  should  depend  upon  the 
degree  of  the  disturbance. 


What  articles  are  required  for  the  preparation  of 
cow's  milk  at  home? 

Feeding-bottles,  rubber  nipples,  an  eight-ounce 
graduated  measuring  glass,  a  glass  or  agate  funnel, 
bottle  brush,  cotton,  alcohol  lamp  or,  better,  a  Bun- 
sen  gas  burner,  a  tall  quart  cup  for  warming  bottles 
of  milk,  a  pitcher  for  mixing  the  food,  a  wide-mouth 
bottle  for  boric  acid  and  one  for  bicarbonate  of  soda, 
and  a  pasteurizer.  Later,  a  double  boiler  for  cooking 
cereals  will  be  needed. 
7 


100       THE  CARE  AND  FEEDING   OF  CHILDREN 

What  bottles  are  to  he-preferred? 

A  cylindrical  graduated  bottle  with  a  rather  wide 
neck,  so  as  to  admit  of  easy  washing,  and  one  which 
contains  no  angles  or  corners.  A  single  size  holding 
eight  ounces  is  quite  sufficient  for  use  during  the  first 
year.  All  complicated  bottles  are  bad,  being  difficult 
to  clean.  One  should  have  as  many  bottles  in  use  as 
the  child  takes  meals  a  day. 

How  should  bottles  be  cared  for? 

As  soon  as  they  are  emptied  they  should  be  rinsed 
with  cold  water  and  allowed  to  stand  filled  with  water 
to  which  a  little  bicarbonate  of  soda  has  been  added. 
Before  the  milk  is  put  into  them  they  should  be 
thoroughly  washed  with  a  bottle  brush  and  hot  soap- 
suds and  then  placed  for  twenty  minutes  in  boiling 
w^ater. 

What  sort  of  nipples  should  he  used? 

Only  simple  straight  nipples  which  slip  over  the 
neck  of  the  bottle.  Those  with  a  rubber  or  glass 
tube  are  too  complicated  and  very  difficult  to  keep 
clean,  tipples  made  of  black  rubber  are  to  be  pre- 
ferred. The  hole  in  the  nipple  should  not  be  so  large 
that  the  milk  will  run  in  a  stream,  but  just  large 
'enough  for  it  to  drop  rapidly  when  the  bottle  with 
the  nipple  attached  is  inverted. 


PREPARATION  OF  COW'S  MILK  AT  HOME      101 

How  should  nipples  he  cared  for? 

'New  nipples  should  be  boiled  foi'  five  minutes; 
but  it  is  unnecessary  to  repeat  this  every  day  as  they 
soon  become  so  soft  as  to  be  almost  useless.  After 
using,  nipples  should  be  carefully  rinsed  in  cold 
water  and  kept  in  a  covered  glass  containing  a  solu- 
tion of  borax  or  boric  acid.  At  least  once  a  day 
they  should  be  turned  wrong  side  out  and  thoroughly 
washed  with  soap  and  water. 

What  sort  of  cotton  should  he  used? 

The  refined  non-absorbent  cotton  is  rather  better 
for  stoppering  bottles,  but  the  ordinary  absorbent 
cotton  will  answer  every  purpose. 

Which  is  better y  the  Bunsen  burner  or  the  alco- 
hol lamp? 

If  there  is  gas  in  the  house,  the  Bunsen  burner 
is  greatly  to  be  preferred,  being  cheaper,  simpler, 
and  much  safer  than  the  alcohol  lamp.  If  the  lamp 
is  used,  it  should  stand  upon  a  table  covered  with  a 
plate  of  zinc  or  tin,  or  upon  a  large  tin  tray.  The 
French  pattern  of  alcohol  lamp  is  the  best. 

Give  the  directions  for  preparing  the  food  ac- 
cording to  any  of  the  above  formulas. 

The  nurse's  hands,  bottles,  tables,  and  all  utensils 
should  be  scrupulously  clean.  First  dissolve  the 
milk  sugar  in  boiling  w^ater,  filtering  if  necessary. 


102       THE  CARE  AND  FEEDING  OF  CHILDREN 

Then  add  the  milk  and, cream  and  lime-water,  mix- 
ing the  whole  in  a  pitcher.  A  sufficient  quantity  of 
food  for  twenty-four  hours  is  always  to  be  prepared 
at  one  time.  This  is  then  divided  into  the  number 
of  feedings  required  for  the  day,  each  feeding  being 
put  in  a  separate  bottle,  and  the  bottle  stoppered 
with  cotton.  The  bottles  should  then  be  cooled  rap- 
idly by  standing,  first  in  tepid  then  in  cold  water, 
and  afterward  placed  in  an  ice  chest.  If  the  milk 
is  to  be  pasteurized  or  sterilized,  this  should  precede 
the  cooling. 

DIRECTIONS    FOE    FEEDII^G    INFANTS 

How  should  the  bottle  he  prepared  at  feeding 
time  f 

It  should  be  taken  from  the  ice  chest,  and  warmed 
by  standing  in  warm  water  which  is  deep  enough 
to  cover  the  milk  in  the  bottle;  it  should  then  be 
thoroughly  shaken  and  the  nipple  adjusted ;  the  nurse 
should  see  that  the  hole  in  the  nipple  is  not  too  large 
nor  too  small. 

How  may  the  temperature  of  the  milk  he  tested? 

Xever  by  putting  the  nipple  in  the  nurse's  mouth. 
Before  adjusting  the  nipple,  a  teaspoonful  may  be 
poured  from  the  bottle  and  tasted,  or  a  few  drops 
may  be  poured  through  the  nipple  upon  the  inner 


DIRECTIONS  FOR  FEEDING  INFANTS  103 

surface  of  the  wrist,  where  it  should  feel  quite  warm 
but  never  hot;  or  a  thermometer  may  be  placed  in 
the  water  in  which  the  bottle  stands.  A  dairy  ther- 
mometer should  be  used,  and  the  temperature  of  the 
water  should  be  between  98°  and  105°  F. 

What  is  a  simple  contrivance  for  "keeping  the 
milk  warm  during  feeding? 

A  small  flannel  bag  with  a  draw  string  may  be 
slipped  over  the  bottle. 

In  what  position  should  an  infant  take  its  bottle  ? 

For  the  first  two  or  three  months  it  is  better, 
except  at  night,  when  it  may  be  undesirable  to  take 
the  infant  from  its  crib,  that  it  be  held  on  the  nurse's 
arm  during  the  feeding;  later  it  may  lie  on  its  side 
in  the  crib  provided  the  bottle  is  held  by  the  nurse 
until  it  has  been  emptied ;  otherwise  a  young  infant 
readily  falls  into  the  bad  habit  of  alternately  sucking 
and  sleeping,  and  often  will  be  an  hour  or  more  over 
its  bottle. 

How  much  time  should  he  allowed  for  one 
feeding  ? 

!N^ever  more  than  twenty  minutes.  The  bottle 
should  then  be  taken  away  and  not  given  until  the 
next  feeding  time.  Under  no  circumstances  should 
an  infant  form  the  habit  of  sleeping  with  the  nipple 
in  its  mouth.    A  sleepy  infant  should  be  kept  awake 


104       THE  CARE  AND  FEEDING  OF  CHILDREN 

by  gentle  shaking  until  the  food  is  taken,  or  the  bot- 
tle should  be  removed  altogether. 

Should  an  infant  he  'played  with  soon  after 
feeding  f 

On  no  account;  such  a  thing  frequently  causes 
vomiting  and  sometimes  indigestion.  After  every 
feeding  the  infant  should  be  allowed  to  lie  quietly 
in  its  crib,  and  disturbed  as  little  as  possible,  either 
by  the  nurse,  the  parents  or  visitors. 

INTERVALS    OF    FEEDING 

How  often  should  a  haby  he  fed  during  the  first 
month? 

Every  two  hours  during  the  day  and  twice  during 
the  night,  or  ten  feedings  in  the  twenty-four  hours. 

At  what  age  may  the  interval  he  made  two  and 
a  half  hours? 

Usually  at  five  or  six  weeks. 

When  may  it  he  increased  to  three  hours? 

Usually  at  two  months. 

Why  should  not  a  child  he  fed  more  frequently? 

It  takes  the  stomach  nearly  two  hours  to  digest  a 
meal  at  two  months,  and  about  two  and  a  half  hours 
at  five  or  six  months,  and  if  the  meals  are  too  near 
together  the  second  one  is  given  before  the  first  has 


DIRECTIONS   FOR  FEEDING   INFANTS 


105 


been  digested  and  vomiting  and  indigestion  result* 
The  meals  should  be  far  enough  apart  to  give  the 
stomach  a  little  time  for  rest  just  before  each  feeding. 


Schedule  for  Feeding  Healthy  Infants  during  the 
First  Year 


Age. 


2d  to  7th  day 

2d  and  8d  weeks 

4th  and  5th  weeks 

6th  to  Ulh  week 

9th  week  to  5th  month 

5th  to  9th  month 

9th  to  12th  month 


Inter- 

Night 

No.  of 

val  be- 

feed- 

feed- 

Quantity 
for  one 

tween 

ings  (10 

ings  in 

meals. 

p.  M.  to 

24 

feeding. 

by  day. 

7  A.  M.). 

hours. 

Hour.. 

Ounces. 

2 

2 

10 

1    -U 

2 

2 

10 

li-3 

2 

1 

10 

2i-3i 

2ir 

1 

8 

3  -5 

3 

1 

7 

4-6 

3 

0 

6 

5-7i 

4 

0 

5 

7  -9 

Quantity 
for  24 
hours. 


Onncet. 

10-15 
15-30 
25-35 
24-40 
28-42 
30-45 
35-45 


This  schedule  gives  the  averages  for  healthy  chil- 
dren. The  smaller  quantities  are  those  required  by 
small  children  whose  digestion  is  not  very  vigorous. 
The  larger  quantities  are  those  required  by  large 
children  with  strong  digestion;  in  very  few  cases 
Avill  it  be  advisable  to  go  above  these  figures. 

The  interval  is  reckoned  from  the  beginning  of 
one  feeding  to  the  beginning  of  the  next  one. 

^Yhen  should  the  interval  between  the  feedings 
he  lengtheried? 

When  there  is  gastric  indigestion  as  shown  by 


106       THE  CARE  AND   FEEDING   OF  CHILDREN 

habitual  vomiting  or  the  -  regurgitation  of  food  long 
after  the  bottle  is  finished ;  also  when  the  appetite  is 
very  poor  so  that  the  infant  regularly  leaves  some 
of  its  food. 

When  should  the  interval  between  the  feedings 
he  shortened? 

This  is  done  much  too  frequently;  it  is  rarely 
advisable  to  feed  any  infant,  except  one  seriously  ill, 
oftener  than  the  time  put  down  in  the  schedule. 

EEGULAEITY    IN    FEEDING 

How  can  a  baby  be  taught  to  be  regular  in  its 
habits  of  eating  and  sleeping? 

By  always  feeding  at  regular  intervals  and  put- 
ting to  sleep  at  exactly  the  same  time  every  day  and 
evening. 

When  should  regular  training  be  begun? 
During  the  first  week  of  life. 

Should  a  baby  be  wakened  to  be  nursed  or  fed  if 
sleeping  quietly? 

Yes,  for  a  few  days.  This  will  not  be  re- 
quired long,  for  with  regular  feeding  an  infant 
soon  wakes  regularly  for  its  meal,  almost  upon  the 
minute. 


STERILIZED  MILK  107 

Should  regularity  in  feeding  he  kept  up  at  night 
as  well  as  during  the  day  f 

Onlj  up  to  nine  or  ten  o'clock ;  after  that  time  a 
baby  should  be  allowed  to  sleep  as  long  as  it  will. 

At  what  age  may  a  well  hahy  go  without  food 
from  10  p.  M.  to  6  or  7  a.  m.  f 

Usually  at  four  months,  and  always  at  five  or  six 
months.  E'ight  feeding  is  one  of  the  most  frequent 
causes  of  wakefulness  and  disturbed  sleep. 

STERILIZED    MILK 

What  is  meant  by  sterilizing  milk? 
Heating    milk    for    the    purpose    of    destroying 
germs. 

Does  all  cows*  milk  contain  germs? 

Yes;  even  when  handled  most  carefully,  milk 
contains  many  germs;  but  when  carelessly  handled, 
and  in  summer,  the  number  is  enormous.  While 
most  of  these  are  harmless  or  cause  only  the  souring 
of  milk,  others  are  occasionally  present  which  may 
produce  serious  diseases  such  as  typhoid  fever,  diph- 
theria, scarlet  fever,  cholera,  tuberculosis,  and  many 
forms  of  diarrhoea. 

Under  what  circumstances  is  it  necessary  to  ster- 
ilize milkf 

1.  In  warm  weather  when  it  cannot  be  obtained 


108       THE  CARE  AND  FEEDING   OP  CHILDREN 

fresh;  hence  always  in  cities  and  towns  during  the 
summer. 

2.  When  one  cannot  be  certain  that  the  cows  are 
healthy,  or  that  the  milk  has  been  carefully  handled. 

3.  When  the  milk  is  to  be  kept  for  any  consider- 
able time  (i.  e.,  over  twenty-four  hours),  especially 
if  no  ice  can  be  had. 

4.  During  epidemics  of  typhoid  fever,  scarlet 
fever,  diphtheria,  or  any  form  of  diarrhoeal  disease. 

What  are  the  two  methods  of  heating  milk? 

The  first  is  kno^vn  as  sterilizing,  in  which  the 
milk  is  heated  to  212°  F.  for  one  hour  or  one  hour 
and  a  half;  the  second  is  kno^vn  as  pasteurizing,  in 
which  the  milk  is  heated  to  155°  or  160°  F.  for 
thirty  minutes.  A  temperature  of  155°  F.  continued 
for  thirty  minutes  is  sufficient  to  kill  the  germs  of 
the  diseases  above  referred  to. 

Will  milk  which  has  been  thus  treated  keep  in- 
definitely ? 

ji^o;  for  although  all  the  living  germs  may  be 
killed,  there  are  many  undeveloped  germs,  or  spores, 
which  are  not  destroyed,  and  which  soon  grow  into 
living  germs.  Milk  heated  to  212°  F.  for  an  hour 
will  keep  upon  ice  for  two  or  three  weeks ;  that  heated 
to  155°  F.  should  be  used  within  24  hours. 


STERILIZED  MILK  109 

Is  milk  which  has  been  sterilized  always  a  safe 
food? 

'No;  for  the  reason  that  the  milk  may  be  so  old, 
so  dirty,  and  so  contaminated  before  sterilizing  thai 
it  may  be  still  unfit  for  food,  though  it  contains  no 
living  germs. 

Is  cow's  milk  rendered  more  digestible  by  being 
heated  in  this  way? 

Sterilizing  milk  does  not  improve  its  digestibility 
but  rather  the  contrary.  Sterilized  milk  should  be 
modified  for  infant  feeding  in  the  same  v^ay  as  milk 
which  has  not  been  heated. 

Is  milk  in  any  way  injured  by  heating  to  2V2^  F. 
for  an  hour? 

There  is  abundant  evidence  that  milk  is  ren- 
dered less  digestible  by  such  heating;  also  that  it  is 
more  constipating,  and  that  for  some  children  its 
nutritive  properties  are  interfered  with,  so  that  it 
may  cause  scurvy ;  this,  however,  is  not  seen  unless 
it  is  continued  as  the  sole  food  for  a  long  period. 
These  objections  are  of  so  much  importance  that  this 
plan  of  heating  milk  is  not  to  be  recommended  for 
general  use. 

When  is  it  advantageous  to  heat  milk  to  212^  F.  ? 

For  use  upon  long  journeys,  such  as  crossing  the 

ocean.      Milk  should  then  be  heated  for  one  hour 


110       THE  CARE  AND   FEEDING   OF  CHILDREN 

iipon  two  successive  days;  without  removing  the  cot- 
ton stoppers  from  the  bottles. 

7s  milk  in  any  way  injured  hy  heating  to  155°  F, 
for  thirty  minutes? 

This  point  is  not  yet  definitely  settled.  Such 
heating  does  not  affect  the  taste  of  milk  and  does 
not  render  it  more  constipating.  The  unfavourable 
effects,  if  there  are  any,  are  so  slight  that  they  need 
not  deter  one  from  the  use  of  pasteurized  milk,  even 
for  long  periods.  The  preference,  however,  should 
always  be  given  to  milk  which  is  so  clean  and  so  fresh 
as  not  to  require  any  heating. 

How  should  milk  he  pasteurized? 

A  convenient  form  of  apparatus  is  that  known 
as  Freeman's  pasteurizer  ^ )  another  is  the  Walker- 
Gordon  pasteurizer.^ 

How  should  milk  he  cooled  after  'pasteurizing? 

Always  by  placing  the  bottles  in  cold  water,  so 
as  to  cool  them  rapidly ;  never  by  letting  them  stand 
at  the  temperature  of  the  room,  or  by  placing  them, 
when  warm,  in  an  ice  box. 

^  This  can  be  obtained  at  411  "West  Fifty-ninth  Street,  New 
York,  with  bottles  and  full  directions ;  a  tin  one,  at  a  cost  of  $3.50, 
and  a  copper  one,  which  is  much  more  durable,  for  $7.00. 

2  Obtained  at  the  same  prices  from  any  of  the  Walker-Gordon 
milk  laboratories. 


MODIFIED  MILK  OF  THE  MILK  LABORATORIES      111 

Why  is  this  precaution  necessary? 

Cooling  in  the  air  or  in  an  ice  box  requires  from 
two  to  four  hours,  and  during  that  time  a  great  many 
of  the  undeveloped  germs  may  mature  and  greatly 
injure  the  keeping  properties  of  the  milk.  In  the 
cold  water,  milk  can  be  cooled  in  from  ten  to  twenty 
minutes  if  the  water  is  frequently  changed,  or  if  ice 
is  added  to  the  water. 

MODIFIED    MILK    OF    THE    MILK    LABORATORIES 

What  is  "  modified  milk "  of  the  milk  labora- 
tories ? 

It  is  milk  containing  definite  proportions  of  the 
fat,  sugar,  proteids,  etc.,  put  up  usually  according 
to  the  prescription  of  a  physician,  who  indicates  how 
much  of  the  different  elements  he  desires.  The  most 
reliable  are  the  laboratories  of  the  Walker-Gordon 
Company,  which  has  branches  in  many  of  the  large 
cities  of  the  United  States. 

This  is  an  excellent  method  of  having  milk  pre- 
pared, since  it  can  be  done  with  greater  care  and 
cleanliness  than  are  possible  in  most  homes.  It  is 
besides  a  great  convenience  if  circumstances  make  it 
impossible  to  prepare  the  milk  properly  at  home. 

The  laboratory  should  be  used  for  infant  feed- 
ing only  by  one  who  is  somewhat  familiar  with  this 
method  of  ordering  milk. 


112       THE  CARE  AND  FEEDING   OF  CHILDREN 


PEPTONIZED    MILK 

What  is  peptonized  milhf 

Milk  in  which  the  proteids  (curd)  have  been  par- 
tially digested. 

How  is  this  accomplished? 

By  the  action  of  a  peptonizing  powder  which  is 
composed  of  a  digestive  agent  known  as  the  extractum 
pancreatis  and  bicarbonate  of  soda,  which  is  added 
to  the  plain  or  diluted  milk.  This  is  sold  in  tubes 
or  in  tablets,  and  it  is  the  active  ingredient  of  the 
peptogenic  milk  powder. 

Describe  the  process. 

The  plain  or  modified  milk  is  placed  in  a  clean 
glass  jar  or  bottle,  and  the  peptonizing  powder, 
which  is  first  rubbed  up  with  a  tablespoonful  of  the 
milk,  is  added  and  the  bottle  shaken.  The  bottle  is 
then  placed  in  a  large  pitcher  or  basin  containing 
water  kept  at  the  temperature  of  about  110°  F.,  or  as 
warm  as  the  hand  can  bear  comfortably,  and  left  for 
ten  to  twenty  minutes  if  the  milk  is  to  be  partially 
peptonized;  for  two  hours  if  it  is  to  be  completely 
peptonized. 

What  taste  has  partially  peptonized  milk? 
INone,  if  peptonizing  is  continued  for  only  ten 
minutes,  but  at  the  end  of  twenty  minutes  it  begins 


PEPTONIZED  MILK  113 

to  be  bitter,  when  the  process  of  digestion  has  gone 
further. 

How  is  the  hitter  taste  avoided  in  partially  pep- 
tonized milk? 

At  the  end  of  ten  or  fifteen  minutes  the  milk  may 
be  placed  in  a  saucepan  and  quickly  raised  to  boiling 
point;  this  kills  the  ferment,  so  that  the  milk  will 
not  become  bitter  when  warmed  a  second  time.  Or, 
the  milk  may  be  rapidly  cooled  by  placing  the  bottles 
first  in  cool  and  then  in  ice  water;  in  this  way  the 
ferment  is  not  destroyed,  and  the  milk  may  become 
bitter  when  warmed  for  feeding. 

Should  the  whole  day's  supply  he  peptonized 
at  once,  or  each  hottle  separately  just  hefore  the 
feeding  ? 

Either  plan  may  be  followed.  If  the  former,  it 
is  better  to  raise  the  milk  to  boiling  point  after  pep- 
tonizing; if  the  latter,  it  should  not  be  peptonized 
more  than  ten  minutes,  for  it  will  continue  to  pep- 
tonize while  it  is  being  taken  by  the  child. 

Is  not  the  hitter  taste  of  completely  peptonized 
milk  a  great  ohstacle  to  its  use? 

E'ot  in  the  case  of  young  infants ;  one  under  four 
or  five  months  old  will  usually  take  it  without  any 
objection  after  two  or  three  feedings;  but  it  cannot 
often  be  used  for  those  who  are  much  older. 


114       THE  CARE  AND  FEEDING  OF  CHILDREN 

How  much  of  the  peptonizing  powder  should  he 
used? 

There  are  required  for  one  pint  of  plain  milk, 
five  grains  of  the  extractum  pancreatis  and  fifteen 
grains  of  bicarbonate  of  soda.  This  quantity  is  usu- 
ally put  up  in  a  single  tube  or  tablet.  In  the  formu- 
las previously  given,  less  than  this  will  be  required ; 
for  the  weaker  formulas,  one  half  or  one  third  of 
the  powder  mentioned  will  be  sufficient  for  one  pint 
of  food.  For  a  single  feeding  of  four  ounces,  one 
may  use  one  eighth  of  a  tube  with  a  weak  formula, 
or  one  sixth  of  a  tube  with  a  stronger  formula. 

What  are  the  advantages  of  peptonized  milh? 

Partially  peptonized  milk  is  useful  for  young  in- 
fants who  have  great  difficulty  in  digesting  the  curd 
of  milk,  sometimes  even  when  diluted  as  already 
described;  completely  peptonized  milk,  during  acute 
attacks  of  indigestion. 

For  how  long  a  period  may  the  use  of  peptonized 
milk  he  continued? 

Completely  peptonized  milk  may  be  used  for  a 
few  days,  or  at  most  a  few  weeks;  partially  pepto- 
nized milk  may  be  used  for  two  or  three  months,  but 
not  indefinitely;  it  should  be  left  off  gradually  by 
shortening  the  time  of  peptonizing,  and  lessening  the 
amount  of  the  powder  used. 


FEEDING  DURING   THE  SECOND  TEAR         115 


FEEDING  DURING  THE  SECOND  YEAR 

If  the  general  directions  given  in  previous  pages 
have  been  followed,  the  infant  will  be  taking  at  eleven 
or  twelve  months  "^ve  meals,  at  four-hour  intervals,  8 
or  9  ounces  at  a  time.  Of  this,  about  two-thirds 
should  be  milk  and  one-third  gruel — i.  e..  Formula 
III,  page  72,  or  Formula  X,  page  74.  Besides  this 
he  will  probably  be  receiving  orange  juice  one  or  two 
ounces  a  day,  and  beef  juice,  one  ounce  a  day. 

How  many  meals  are  required  in  the  second  year? 

Usually  five  meals.  Some  children  will  sleep  from 
6  p.  M.  to  6  A.  M.  without  waking,  but  unless  there 
is  a  feeding  at  10  p.  m.  children  are  apt  to  wake  very 
early  in  the  morning. 

Should  each  feeding  he  prepared  at  the  time  given^ 
or  all  feedings  together,  as  during  the  first  year? 

During  the  second  and  third  years  it  is  better  to 
prepare  the  milk  for  the  entire  day  at  one  time. 

Later,  when  only  plain  milk  is  used,  the  quanti- 
ties needed  for  the  different  feedings  should  be  put 
into  one  or  into  two  bottles,  which  then  may  be  pas- 
teurized or  not  as  may  be  necessary.  In  this  way 
the  different  feedings  are  kept  separate,  and  the 
day's  supply  of  milk  is  not  disturbed  every  time  the 
child  is  fed,  as  otherwise  is  unavoidable.  The  food 
8 


116       THE  CARE  AND   FEEDING  OF  CHILDREN 

should  be  prepared  as  soon  as  possible  after  the  daily 
milk  supply  is  delivered  in  the  morning. 

What  changes  may  now  he  made  in  the  food? 
The  proportion  of  milk  in  the  food  may  be  in- 
creased ;  the  lime  water  and  milk  sugar  may  be  grad- 
ually omitted ;  broth  may  be  added  to  one  of  the  feed- 
ings. The  child  should  begin  to  take  at  least  part 
of  his  food  from  the  cup. 

Give  a  proper  diet  for  an  average  healthy  child 
of  twelve  months. 

6.30  A.  M.     Milk,  six  to  seven  ounces ;   diluted  with  barley  or  oat 
gruel,  two  to  three  ounces;   after  the  thirteenth 
month,  taken  from  a  cup. 
9  A.  M.     Orange  juice,  one  to  two  ounces. 

10  A.  M.    Milk,  two  parts ;    oatmeal  or  barley  gruel,  one  part ; 
from  ten  to  twelve  ounces  in  all  may  be  allowed ; 
it  should  be  given  from  a  cup. 
2  P.  M.    Beef  juice,  one  to  two  ounces ; 

or,  the  white  of  one  egg,  slightly  cooked ;  later  the 

entire  egg ; 
or,  mutton  or  chicken  broth,  four  to  six  ounces. 
Milk  and  gruel   in  proportions  above  given,  four  to 
six  ounces. 
6  p.  M.    Same  as  at  10  a.  m. 
10  p.  M.    Same  as  at  6.30  a.  m.,  except  that  the  milk  may  be 
given  from  the  bottle. 

How  long  may  this  schedule  he  followed? 

Usually  until  the  fourteenth  or  fifteenth  month. 
After  this  time  the  cereals  may  be  given  much  thicker 
and  fed  from  a  spoon. 


FEEDING  DURING  THE  SECOND  YEAR  117 

May  any  other  fruit  juices  he  given  at  this 
period  9 

Orange  juice  is  the  best;  next  to  this  the  juice 
of  fresh  ripe  peaches,  red  raspberries  or  strawberries. 
All  these  should  be  strained  very  carefully  through 
muslin  to  make  sure  that  the  child  gets  none  of  the 
pulp  or  seeds,  either  of  which  may  cause  serious 
disturbance.  Of  the  orange  or  peach  juice,  from 
one  to  four  tablespoonfuls  may  be  allowed  at  one 
time;  of  the  others  about  half  the  quantity.  The 
fruit  juice  is  best  given  one  hour  before  the  second 
feeding. 

When  should  a  child  he  weaned  from  its  bottle? 

Most  children  can  and  should  be  taught  to  take 
their  food  from  the  cup  or  spoon  by  the  time  they 
are  thirteen  months  old ;  but  it  is  convenient  to  give 
the  10  p.  M.  feeding  from  the  bottle  during  the 
greater  part  of  the  second  year  (see  page  52). 

Give  a  proper  diet  for  an  average  child  from  the 
fourteenth  to  the  eighteenth  month. 

The  bottle  should  not  be  given  except  at  night. 
Cereals  may  now  form  an  important  part  of  the  diet. 
They  should  be  very  thoroughly  cooked,  usually  for 
three  hours,  and  strained. 


118       THE  CARE  AND  FEEDING   OF  CHILDREN 

The  daily  schedule  should  be  about  as  follows : 
6.30  A.  M.    Milk,  warmed,  eight  to  ten  ounces,  given  from  a  cup. 
9  A.  M.    Fruit  juice,  one  to  three  ounces. 

10  A.  M.    Cereal :  one,  later  two  or  three,  tablespoonfuls  of  oat- 
meal, hominy  or  wheaten  grits,  cooked  for  at 
least  three  hours  and  strained ;  upon  this  from  one 
to  two  ounces  of  thin  cream,  or  milk  and  cream, 
with  plenty  of  salt,  but  without  sugar. 
Crisp  dry  toast,  one  piece ; 
or,  unsweetened  zwieback ; 
or,  one  Huntley  and  Palmer  breakfast  biscuit. 
Milk,  warmed,  six  to  eight  ounces,  from  a  cup. 
a  P.M.    Beef  juice,  one  to  two  ounces;   and  one  egg  (soft 
boiled,  poached  or  coddled) ;  and  boiled  rice,  one 
tablespoonf  ul ; 
or,  broth  (mutton  or  chicken),  four  ounces ;  one  or 
two  Huntley  and  Palmer  breakfast  biscuits,  or 
zwieback ;  and  (if  most  of  the  teeth  are  present) 
rare  scraped  meat,  at  first  one  teaspoonful,  grad- 
ually increasing  to  one  tablespoonful. 
6  P.  M.    Cereal :  two  tablespoonfuls  of  farina,  cream  of  wheat, 
or  arrowroot,  cooked  for  at  least  one  half  hour, 
with  milk,  plenty  of  salt,  but  without  sugar. 
Milk,  warmed,  eight  to  ten  ounces,  given  from  a  cup. 
10  P.  M.     Milk,  warmed,  eight  to  ten  ounces,  which  may  be 
given  from  a  bottle. 

Give  a  proper  diet  for  an  average  child  from  the 
eighteenth  month  to  the  end  of  the  second  year. 

The  same  order  of  meals  as  for  the  months  just 
preceding  should  be  followed.  For  most  children 
milk  at  10  p.  m.  is  desirable.  There  are  many,  how- 
ever, who  sleep  regularly  from  6  p.  m.  until  6  a.  m. 


FEEDING  DURING  THE  SECOND  YEAR  119 

without  food;  for  such  the  night  feeding  should,  of 

course,  not  be  insisted  upon. 

The  daily  schedule  should  be  about  as  follows : 

6.30  A.  M.    Milk,  warmed,  ten  to  twelve  ounces,  given  from  cup. 
9  A.  M.    Fruit  juice,  two  to  three  ounces. 
A.  M.     Cereals :  similar  to  those  given  from  the  fourteenth 
to  the   eighteenth    month ;    they  need   not   be- 
strained  although  they  should  be  cooked   and 
served  in  the  same  way. 
Crisp  dry  bread,  zwieback,  or  Huntley  and  Palmer 

biscuits,  without  butter. 
Milk,  warmed,  one  cup. 
2  P.  M.    Beef  juice  and  one  egg ; 

or,  broth  and  meat;   care  being  taken  that  the- 
meat  is  always  rare  and  scraped  or  very  finely 
divided;  beefsteak,  mutton  chop,  or  roast  beef 
may  be  given. 
Very  stale  bread,  or  two  pieces  of  zwieback. 
Prune  pulp  or  baked  apple,  one  to  two  tablespoonful& 
Water ;  no  milk. 
6  P.  M.     Cereal :  farina,  cream  of  wheat,  or  arrowroot,  cooked 
for  at  least  one  half  hour,  with  milk,  plenty  of 
salt,  but  without  sugar, 
or,  milk  toast  or  stale  bread  and  milk, 
10  p.  M.    If  required,  ten  to  twelve  ounces  of  plain  milk. 

What  fruits  may  he  given  at  this  period? 

If  the  child  has  a  feeble  digestion,  only  the  fruit 
juices  previously  allowed ;  strong  children  may  have^ 
in  addition  prune  pulp,  baked  apple,  and  apple- 
sauce. The  prune  pulp  is  prepared  by  stewing  the 
dried  prunes  without  sugar  until  they  are  very  soft^ 


120       THE  CARE  AND  FEEDING  OF  CHILDREN 

and  removing  all  the  skin  by  putting  the  fruit 
through  a  strainer;  of  this  from  one  to  two  table- 
spoonfuls  may  be  given  at  one  time.  The  baked 
apple  should  be  given  without  cream,  and  the  apple- 
sauce should  have  very  little  sugar. 

How  and  when  should  water  he  given  f 
Throughout  the  second  year  water  should  be 
given  freely  between  the  feedings,  especially  in  warm 
weather;  from  one  to  three  ounces  may  be  given  at 
one  time,  either  from  a  spoon,  a  glass,  or  a  bottle. 
The  water  should  be  boiled  daily  and  then  cooled. 
It  should  not  be  allowed  to  stand  in  the  room,  but 
fresh  water  should  be  put  into  the  bottle  each  time. 

FEEDING  DURING  THE  THIRD  YEAR 

What  changes  may  he  made  in  the  diet  during 
the  third  year? 

The  night  feeding  at  10  p.  m.  should  be  omitted. 
A  greater  quantity  of  solid  food  may  be  allowed, 
particularly  at  the  mid-day  meal.  It  is  not  advisable 
to  begin  potato  and  other  vegetables  until  this  age  is 
reached.  Three  regular  meals  should  be  given  and 
milk  once  besides,  either  between  the  breakfast  and 
dinner  or  dinner  and  supper,  whichever  is  the  longer 
interval.  Water  should  be  allowed  freely  between 
meals. 


FEEDING  DURING   THE  THIRD  YEAR  121 

What  would  he  a  proper  schedule  for  an  average 
child  during  the  third  year? 

7.30  A.M.     Cereal:    cooked   (preferably  over  night)   for    three 
hours,  although  a  somewhat  larger  variety  may 
be  given  than  during  the  second  year ;  given  as 
before  with  milk  or  thin  cream,  salt,  but  very 
little  sugar. 
"Warm  milk,  one  glass. 
A  soft  egg,  poached,  boiled  or  coddled. 
Bread,  very  stale  or  dry,  one  slice,  with  butter. 
10  A.  M.    "Warm  milk,  one  cup,  with  a  cracker  or  piece  of  very 

stale  bread  and  butter. 
2  P.  M.     Soup,  four  ounces  ; 

or,  beef  juice,  two  ounces. 
Meat :  chop,  steak,  roast  beef  or  lamb  or  chicken. 
A  baked  white  potato ; 

or,  boiled  rice  or  spaghetti ;  both  cooked  five  hours. 

Green  vegetable :  asparagus  tips,  string  beans,  peas, 

spinach ;  all  to  be  cooked  until  very  soft,  and 

mashed,  or  preferably  put  through  a  sieve ;  at 

first,  one  or  two  teaspoonfuls. 

Dessert :  cooked  fruit — baked  or  stewed  apple,  stewed 

prunes. 
Water ;  no  milk. 
6  P.  M.    Cereal :  farina,  cream  of  wheat,  or  arrowroot,  cooked 
for  at  least  one  half  hour,  with  plenty  of  salt,  but 
without  sugar ; 
•  ■  or,  milk  toast ; 
or,  bread  and  milk  ; 

or,  stale  or  dry  bread  and  butter  and  a  glass  of 
milk. 


PAET  III 
THE   DIET    OF    OLDER    CHILDREN 


Ill 

THE  DIET  OF  OLDER  CHILDREN 
(FOURTH  TO  TENTH  YEAR) 

Throughout  this  period  the  largest  meal  should 
always  be  in  the  middle  of  the  day,  and  a  light  sup- 
per given,  very  much  like  that  described  for  the  third 
year.  During  the  first  half  of  this  period,  milk  may 
be  allowed  once  either  between  breakfast  and  dinner 
or  dinner  and  supper ;  no  other  eating  between  meals 
should  be  permitted,  but  water  should  be  allowed 
freely. 

MILK    AND    CREAM 

What  part  of  the  diet  should  milk  form  during 
childhood? 

It  should  form  a  very  important  part  up  to  the 
tenth  year;  nothing  can  take  its  place.  There  are 
comparatively  few  children  who  cannot  take  and 
digest  milk  if  it  is  properly  fed. 

Why  is  milk  so  advantageous'^ 
Because  no  food  that  we  possess  has  so  high  a 
ixutritive  value  as  milk,  for  the  amount  of  work  re- 

125 


126       THE   CARE  AND  FEEDING  OF  CHILDREN 

quired  of  the  organs  of  digestion.     It  is,  therefore, 
peculiarly  adapted  to  the  diet  of  the  child. 

What  are  the  essential  joints  in  the  use  of  milhf 
It  should  be  clean  and  fresh,  but  not  too  rich.  It 
is  a  mistake  to  select  for  any  children  the  rich  milk 
of  a  Jersey  herd  and  use  it  as  though  it  were  an 
ordinary  milk.  For  children  who  have  difficulty  in 
digesting  milk,  it  should  be  somewhat  diluted,  i.  e., 
one  part  of  water  to  four  parts  of  milk,  or  salt  or 
bicarbonate  of  soda  should  be  added.  It  is  also  im- 
portant not  to  give  milk  at  meals  when  fruits,  espe- 
cially sour  fruits,  are  allowed. 

How  much  milk  may  advantageously  he  given? 

The  average  child  with  good  digestion  should 
take  from  one  and  one  half  pints  to  one  quart  of 
milk  daily,  this  including  not  only  what  the  child 
drinks  but  what  is  served  upon  cereals  and  in  other 
ways.  It  is  seldom  wise  to  allow  a  child  to  take  as 
much  as  two  quarts  daily,  as  a  more  mixed  diet  for 
most  children  is  better. 

To  what  extent  may  cream  he  used? 

Older  children  do  not  require  so  large  a  propor- 
tion of  fat  in  their  food  as  do  infants,  and  the  use 
of  cream,  especially  very  rich  cream,  often  results  in 
disturbances  of  digestion.  The  use  of  too  much  or 
too  rich  cream  is   a  common  cause  of  the  coated 


THE  DIET  OF  OLDER  CHILDREN  127 

tongue,  foul  breath  and  pale  gray  stools,  often  called 
"  biliousness." 

Is  not  cream  useful  in  overcoming  the  constipa- 
tion of  children? 

With  infants  it  is  valuable  to  a  certain  point,  but 
mth  older  children  only  to  a  limited  degree,  and  if 
such  symptoms  as  those  above  described  are  present, 
cream  should  not  be  given. 

EGGS 

To  what  extent  may  eggs  he  used  in  the  diet  of 
this  period? 

They  form  a  most  valuable  food.  It  is  essential 
that  they  should  be  fresh  and  only  slightly  cooked, 
soft  boiled,  poached  or  coddled;  fried  eggs  should 
never  be  given  and  all  omelets  are  objectionable. 

Which  is  more  digestible,  the  white  or  yolk  of 
the  egg? 

For  the  great  majority  of  children,  the  white  of 
the  egg.  This  forms  one  of  the  most  digestible  pro- 
teids  we  possess,  and  can  be  used,  even  in  the  latter 
part  of  the  first  year,  with  advantage. 

Is  it  not  true  that  eggs  often  cause  ^'  bilious- 
ness''? 

Very  seldom,  if  fed  as  above  advised.  This  is 
an  old  prejudice  but  has  little  basis  in  fact. 


138        THE  CARE  AND  FEEDING  OF  CHILDREN 

How  often  may  eggs  he  given  f 

Most  children  from  four  to  ten  years  old  will 
take  one  egg  for  breakfast  and  another  for  supper 
for  an  indefinite  period  with  relish  and  benefit. 
There  are,  however,  some  few  who  have  a  peculiar 
idiosyncrasy  as  regards  eggs  and  cannot  take  them 
at  all. 

MEAT    AI^D    FISH 

What  meats  may  he  given  to  young  children? 

The  best  are  beefsteak,  mutton-chop,  roast  beef, 
roast  lamb,  broiled  chicken  and  certain  delicate  fish, 
such  as  shad  or  bass. 

What  are  the  important  'points  to  he  considered 
in  giving  meat  to  children? 

Most  meats  should  be  rare  and  either  scraped  or 
very  finely  divided,  as  no  child  can  be  trusted  to 
chew  meat  properly.  Meats  are  best  broiled  or 
roasted,  but  should  not  be  fried. 

How  often  should  meat  he  given? 

At  this  period,  only  once  a  day,  at  the  mid-day 
meal. 

7s  not  the  excessive  nervousness  of  many  modern 
children  due  to  the  giving  of  meat,  or  at  least  aggra- 
vated hy  its  u£e? 

There  is  little  ground  for  such  a  belief,  unless 
an  excessive   amount  of  meat  is  given.     Certainly 


THE  DIET  OF  OLDER  CHILDREN  129 

cutting  off  meat  from  the  diet  of  nervous  children 
seldom  produces  any  striking  benefit. 

What  meats  should  he  forbidden  to  young  chil- 
dren? 

Ham,  bacon,  sausage,  pork,  liver,  kidney,  game 
and  all  dried  and  salted  meats,  also  cod,  mackerel 
and  halibut;  all  of  these  are  best  withheld  until  the 
child  has  passed  the  tenth  year. 

Are  not  gravies  beneficial  and  nutritious? 

The  beef  juice,  or  so-called  "  platter  gravy,"  from 
a  roast  is  exceedingly  nutritious  and  desirable,  but 
many  of  the  thickened  gravies  are  much  less  diges- 
tible and  are  too  often  given  in  excess ;  only  a  small 
quantity  should  be  allowed.  They  should  not  form 
an  important  part  of  the  meal. 

VEGETABLES 

What  vegetables  may  be  used  at  this  period? 

White  potatoes  may  be  given  first.  These  should 
preferably  be  baked  or  boiled  and  mashed,  but  never 
fried.  They  should  be  served  with  beef  juice  or 
with  cream  rather  than  with  butter. 

Of  the  green  vegetables,  the  best  are  peas,  spinach, 
asparagus  tips,  string  beans,  stewed  celery,  young 
beets,  or  carrots,  and  squash.  Baked  sweet  potato, 
turnips,  boiled  onions  and  cauliflower,  all  well  cooked. 


130       THE  CARE  AND  FEEDING  OF  CHILDREN 

may  be  given  after  the  sixth  or  seventh  year  in  mod- 
erate amount. 

The  principal  trouble  in  the  digestion  of  vege- 
tables is  due  to  imperfect  cooking.  It  is,  in  fact, 
almost  impossible  to  cook  them  too  much ;  they  should 
also  be  very  finely  mashed.  They  form  a  valuable 
addition  to  the  diet  after  three  years,  although  the 
amount  at  first  given  should  be  small,  one  or  two 
teaspoonfuls.  They  greatly  aid  in  securing  regu- 
larity of  the  bowels.  Because  small  particles  are 
seen  in  the  stools,  it  is  not  to  be  inferred  that  they 
are  causing  disturbance  and  should,  therefore,  be 
stopped,  but  only  that  they  should  be  more  thor- 
oughly cooked  and  more  finely  divided  before  being 
given. 

7s  it  safe  to  use  canned  vegetables  for  chil- 
dren f 

Many  of  the  best  brands  of  canned  vegetables  are 
quite  safe  and  some,  such  as  peas  and  asparagus, 
can  be  used  with  advantage.  They  are  frequently 
better  than  stale  green  vegetables  often  sold  in  the 
markets. 

What  vegetables  should  not  he  given  to  young 
children? 

None  of  those  which  are  eaten  raw,  such  as 
celery,  radishes,  onions,  cucumbers,  tomatoes  or  let- 


THE  DIET  OF  OLDER  CHILDREN  131 

tuce.  Certain  others,  even  when  well  cooked,  should 
not  be  allowed;  as  corn,  lima  beans,  cabbage,  egg 
plant.  E'one  of  these  should  be  given  until  a  child 
has  passed  the  age  of  ten  years. 

Are  vegetable  salads  to  he  given? 

As  a  rule  salads  of  all  kinds  should  be  omitted 
until  a  child  has  passed  the  tenth  year.  Salads  are 
difficult  to  digest  and  a  cause  of  much  disturbance 
in  children  of  all  ages. 

CEREALS 

What  are  the  most  important  points  in  selecting 
and  preparing  cereals? 

The  important  things  are  that  they  are  properly 
cooked  and  not  used  in  excess.  The  ready-to-serve 
cereals  should  never  be  chosen  for  children,  nor 
should  a  child,  because  he  is  fond  of  cereals,  be 
allowed  to  make  his  entire  meal  of  them,  taking  two 
or  three  saucerfuls  at  a  feeding. 

Many  of  the  partially  cooked  preparations  of 
oatmeal  and  wheat  are  excellent,  but  should  be  cooked 
for  a  much  longer  time  than  is  stated  upon  the  pack- 
age, usually  three  or  four  times  as  long.  Digesti- 
bility is  chiefly  a  matter  of  proper  cooking.  Most  of 
the  grains, — oatmeal,  hominy,  rice,  wheaten  grits, — 

require  at  least  three  hours'  cooking  in  a  double  boiler 
9 


132       THE  CARE  AND   FEEDING   OF  CHILDREN 

in  order  to  be  easily  digested.  The  prepared  flours, 
• — corn  starch,  arrowroot,  barley, — should  be  cooked 
at  least  twenty  minutes.  I  know  of  no  preparation 
in  the  modern  market  which  requires  no  cooking, 
"which  is  to  be  recommended  for  children. 

How  are  cereals  to  he  given? 

Usually  with  milk  or  a  mixture  of  milk  and 
cream;  always  with  an  abundance  of  salt  and  with 
very  little  or  no  sugar,  one  half  teaspoonful  on  a 
eaucerful  of  cereal  should  be  the  limit. 

Cereals  should  not  be  served  with  syrups  or  but- 
ter and  sugar. 


BROTHS    AND    SOUPS 

What  broths  and  soups  are  to  he  recommended? 

Meat  broths  are  generally  to  be  preferred  to 
vegetable  broths, — mutton  or  chicken  being  usually 
most  liked  by  children.  INTearly  all  plain  broths  may 
be  given.  Those  thickened  with  rice,  barley  or  corn 
starch  form  a  useful  variety,  especially  with  the 
addition  of  milk. 

Vegetable  purees  of  peas,  spinach,  celery  or 
asparagus  may  be  used  for  children  over  seven  years 
old.  Tomato  soup  should  not  be  given  to  young 
children. 


THE  DIET  OF  OLDER  CHILDREN  133 


BREAD,    CRACKERS    AI^D    CAKES 

What  forms  of  hreadstuffs  are  best  suited  to 
young  children? 

Fresh  bread  should  not  be  given,  but  stale  bread 
cut  thin  and  freshly  dried  in  the  oven  until  it  is 
crisp  is  very  useful,  also  zwieback,  the  unsweetened 
being  preferred.  Oatmeal,  graham  or  gluten  crack- 
ers, and  the  Huntley  and  Palmer  breakfast  biscuits, 
stale  rolls,  or  corn  bread  which  has  been  split  and 
toasted  or  dried  till  crisp,  form  a  sufficient  variety 
for  most  children. 

What  hreadstuffs  should  he  forhiddenf 
All  hot  breads,  all  fresh  rolls,  all  buckwheat  and 
other  griddle  cakes,  all  fresh  sweet  cakes,  especially 
those  covered  with  icing  and  those  containing  dried 
fruits.  A  stale  lady-finger  or  piece  of  sponge  cake 
is  about  as  far  in  the  matter  of  cakes  as  it  is  wise  to 
go  with  children  up  to  seven  or  eight  years  old. 

DESSERTS 

What  desserts  may  he  given  to  young  children? 

Mistakes  are  more  often  made  here  than  in  any 
other  part  of  the  child's  diet.  Up  to  six  or  seven 
years,  only  junket,  plain  rice  pudding  without  rai- 


134       THE  CARE  AND  FEEDING  OF  CHILDREN 

sins,  plain  custard  and,  not  more  than  once  a  week, 
a  small  amount  of  ice  cream. 

What  should  he  especially  forbidden? 

All  pies,  tarts  and  pastry  of  every  description, 
jam,  syrups  and  preserved  fruits;  nuts,  candy  and 
dried  fruits. 

Does  "  a  little  "  do  any  harm  ? 

Yes,  in  that  it  develops  a  taste  for  this  sort  of 
food,  after  which  plainer  food  is  taken  with  less 
relish.  Besides  the  "  little  "  is  very  apt  soon  to  he- 
come  a  good  deal. 

Does  not  the  child's  instinctive  craving  for  sweets 
indicate  his  need  of  them? 

That  a  child  likes  or  craves  sweets  is  the  usual 
excuse  of  an  indulgent  parent.  Every  child  likes 
his  own  way,  but  that  is  no  reason  why  he  should  not 
be  trained  to  obedience  and  self-control;  a  child's 
fondness  for  sweets  can  hardly  be  considered  a  nor- 
mal instinct.  As  a  matter  of  fact,  supported  by 
everyday  experience,  no  causes  are  productive  of 
more  disorders  of  digestion  than  the  free  indulgence 
in  desserts  and  sweets  by  young  children.  It  is  a  con- 
stantly increasing  tendency,  not  easily  controlled  as 
a  child  grows  older;  and  in  early  childhood,  the  only 
safe  rule  is  to  give  none  at  all. 


THE  DIET  OF  OLDER  CHILDREN  135 


FEUITS 

Are  fruits  an  essential  or  important  part  of  the 
diet? 

They  are  a  very  important  part  and  should  be 
begun  in  infancy.  They  are  particularly  useful  for 
the  effect  they  have  upon  the  bowels.  It  is  important 
that  they  should  be  selected  with  care  and  given  with 
much  discretion,  especially  in  cities.  In  the  country 
where  fruit  is  absolutely  fresh,  a  somewhat  greater 
latitude  may  be  allowed  than  is  given  below. 

What  fruits  may  safely  he  given  to  children  up 
to  five  years  old? 

As  a  general  rule,  only  cooked  fruits  and  the 
juices  of  fresh  fruits. 

What  fruit  juices  may  he  used? 

That  from  sweet  oranges  is  the  best,  but  the  fresh 
juice  of  grape  fruit,  peaches,  strawberries  and  rasp- 
berries may  also  be  used. 

What  stewed  fruits  may  he  given? 
Stewed  or  baked  apples,  prunes,  pears,  peaches 
and  apricots. 

What  raw  fruits  are  to  he  particularly  avoided 
with  young  children? 

The  pulp  of  oranges  or  grape  fruit,  also  cherries, 
berries,  bananas  and  pineapple. 


136       THE  CARE  AND  FEEDING  OP  CHILDREN 

What  precautions  should  he  emphasized  regard- 
ing the  use  of  fruits? 

That  they  should  be  used  with  greater  care  in 
hot  "weather  and  with  children  who  are  prone  to 
attacks  of  intestinal  indigestion. 

What  symptoms  indicate  that  fruits  should  he 
avoided P 

A  tendency  to  looseness  of  the  bowels  with  the 
discharge  of  mucus,  or  frequent  attacks  of  abdominal 
pain  or  stomach  ache. 

Is  there  any  special  choice  of  meals  at  which  fruit 
should  he  given? 

The  fruit  juice  given  early  in  the  morning,  upon 
an  empty  stomach,  works  more  actively  upon  the 
bowels  than  if  it  is  given  later  in  the  day. 

It  is  not,  as  a  rule,  wise  to  give  cream  or  milk 
with  sour  fruits.  Usually  the  fruit  is  best  given  at 
the  mid-day  meal,  as  a  dessert,  at  a  time  when  no 
milk  is  taken.  It  is  in  all  cases  important  that  the 
quantity  of  fruit  should  be  moderate. 

What  hesides  water  and  milk  should  a  child  he 
allowed  to  drinh  and  what  should  he  forhidden? 

Tea,  coffee,  wine,  beer  and  cider  in  all  quantities 
and  in  all  forms  should  be  forbidden  to  young  chil- 
dren below  puberty.  Cocoa  which  is  made  very 
weak,  i.  e.,  almost  all  milk,  is  often  useful  as  a  hot 


INDIGESTION  IN  OLDER  CHILDREN  137 

drink.  Lemonade,  soda-water,  etc.,  should  if  pos- 
sible be  deferred  until  the  tenth  year.  A  free  in- 
dulgence in  things  of  this  kind  should  never  be  per- 
mitted with  children  of  seven  or  eight  years. 


INDIGESTION  IN  OLDER  CHILDREN 

What  are  the  different  ways  in  which  indigestion 
shows  itself  in  children'^ 

First,  in  acute  disturbances  which  last  for  a  few 
days  only;  and,  secondly,  in  chronic  disturbances 
which  may  continue  for  weeks  or  months. 

Which  of  the  two  forms  of  indigestion  is  more 
likely  to  impair  seriously  the  health  of  the  child? 

Chronic  indigestion;  for  since  the  cause  is  not 
recognized  it  often  goes  on  for  months  and  even 
years  unchecked. 

What  are  the  symptoms  of  acute  indigestion? 

These  are  familiar  and  easily  recognized.  They 
are  vomiting,  pain,  undigested  movements  from  the 
bowels,  often  fever  and  considerable  prostration. 

Such  attacks  are  usually  traceable  to  their  proper 
cause,  the  removal  of  which  is  followed  by  prompt 
recovery. 


VdS       THE  CARE  AND  FEEDING  OF  CHILDREN 

What    are    the    common    causes    of    acute    indi- 
gestion? 

This  is  frequently  due  to  overeating,  to  indul- 
gence in  some  special  article  of  improper  food,  or  to 
eating  heartily  when  overtired.  Acute  indigestion 
often  marks  the  beginning  of  some  acute  general 
illness. 

How  should  acute  indigestion  he  managed? 

One  should  bear  in  mind  that  for  the  time  being 
the  digestive  organs  have  stopped  work  altogether. 
The  important  thing,  therefore,  is  to  clear  out  from 
the  intestines  all  undigested  food  by  some  active 
cathartic,  such  as  castor  oil.  The  stomach  has  usu- 
ally emptied  itself  by  vomiting.  All  food  should  be 
stopped  for  from  twelve  to  thirty-six  hours,  accord- 
ing to  the  severity  of  the  attack,  only  water  being 
given. 

At  the  end  of  this  time  is  it  safe  to  begin  with 
the  former  diet? 

No;  for  such  a  procedure  is  almost  certain  to 
cause  another  attack  of  indigestion.  At  first  only 
broth,  thin  gruel,  very  greatly  diluted  milk,  or  whey 
should  be  given.  The  diet  may  be  very  slowly  but 
gradually  increased  as  the  child's  appetite  and  diges- 
tion improve,  but  in  most  cases  a  week  or  ten  days 
should  elapse  before  the  full  diet  is  resumed. 


INDIGESTION  IN  OLDER  CHILDREN  139 

What  are  the  symptoms  of  chronic  indigestion? 

These,  although  familiar,  are  not  so  easily  dis- 
tinguished and  are  very  often  attributed  to  the  wrong 
cause.  There  are  usually  general  symptoms  such  as 
indisposition,  disturbed  sleep,  grinding  of  the  teeth, 
fretfulness,  languor,  loss  of  weight  and  anaemia. 
There  are  besides  local  symptoms :  flatulence,  abdom- 
inal pain,  abdominal  distention,  constipation,  or 
looseness  of  the  bowels  with  mucus  in  the  stools,  foul 
breath,  coated  tongue,  loss  of  appetite,  or  an  ab- 
normal, capricious  appetite.  Such  symptoms  are 
often  wrongly  ascribed  to  intestinal  worms. 

What  are  the  common  caiLses  of  chronic  indi- 
gestion f 

This  is  generally  the  result  of  a  bad  system  of 
feeding,  either  the  prolonged  use  of  improper  food 
or  of  improper  methods  of  feeding. 

Examples  of  bad  methods  of  feeding  are,  coaxing 
or  forcing  to  eat,  rapid  eating  with  insufficient  mas- 
tication, eating  between  meals,  allowing  a  child  to 
have  his  own  way  in  selecting  his  food,  as  when  he 
lives  largely  upon  a  single  article  of  diet.  Things  to 
be  considered  under  the  head  of  improper  food  are, 
indulgence  in  sweets,  desserts,  etc.,  the  use  of  imper- 
fectly cooked  foods,  especially  cereals  and  vegetables, 
and  of  raw  or  stale  fruits. 


140       THE  CARE  AND  FEEDING  OP  CHILDREN 

Is  it  not  true  that  a  diet  or  a  special  article 
of  food  which  does  not  make  a  child  ill  is  proof 
that  such  a  diet  or  such  a  food  is  proper  for  a 
child? 

By  no  means;  with  many  people  the  only  guide 
in  feeding  children  is  that  the  article  in  question  did 
not  make  the  children  sick,  therefore  it  is  allowable. 
This  is  a  very  bad  principle.  A  better  one  is  to  adopt 
such  a  diet  as  will  nourish  the  child's  body  with  the 
least  possible  tax  upon  his  digestive  organs ;  in  other 
words,  to  exclude  articles  which  experience  has  shown 
to  be  injurious  to  most  children. 

How  should  chronic  indigestion  he  managed? 

This  is  a  much  more  difficult  matter  than  the 
treatment  of  acute  indigestion,  for,  as  it  is  usually 
the  result  of  the  prolonged  use  of  improper  food  or 
of  an  improper  method  of  feeding,  a  cure  can  be 
accomplished  only  by  a  discovery  and  removal  of 
the  cause. 

7s  chronic  indigestion  curable? 

In  the  vast  majority  of  cases  it  is  so,  but  only 
by  faithfully  observing  for  a  long  period  the  rules 
for  simple  feeding  laid  down  elsewhere.  One  of  the 
greatest  difficulties  in  the  way  of  recovery  is  that 
parents   and  nurses   are   unwilling  to   follow  a   re- 


GENERAL  RULES  TO  BE  OBSERVED  IN  FEEDING    141 

stricted  diet  long  enough  to  secure  a  complete  cure, 
or  to  change  radically  their  methods  of  feeding, 
but  expect  the  child  to  recover  by  simply  taking 
medicine. 

For  how  long  a  'period  is  it  necessary  to  continue 
very  careful  feeding'^ 

In  any  case  it  must  be  done  for  several  months ; 
with  most  children  for  two  or  three  years ;  with  some, 
throughout  childhood,  for  with  them  the  slightest 
deviation  from  established  rules  is  sure  to  provoke  a 
relapse. 

7s  not  medicine  useful? 

It  is  undoubtedly  of  assistance  for  the  relief  of 
some  symptoms,  but  the  essential  thing  .is  proper 
feeding,  without  which  nothing  permanent  can  be 
accomplished.  ' 


GENERAL  RULES  TO  BE  OBSERVED  IN 
FEEDING 

Bad  habits  of  eating  are  readily  acquired  but 
difficult  to  break. 

Young  children  should  not  be  allowed  to  play 


142       THE  CARE  AND  FEEDING  OF  CHILDREN 

with  their  food,  nor  should  the  habit  be  formed  of 
amusing  or  diverting  them  while  eating,  because  by 
these  means  more  food  is  taken. 

Older  children  should  not  be  permitted  to  make 
an  entire  meal  of  one  thing,  no  matter  how  proper 
this  may  be. 

Children  who  are  allowed  to  have  their  own 
way  in  matters  of  eating  are  very  likely  to  be 
badly  trained  in  other  respects ;  while  those  who  have 
been  properly  trained  in  matters  of  eating  can  usu- 
ally be  easily  trained  to  do  anything  else  that  is 
important. 

Learning  to  eat  proper  things  in  a  proper  way 
forms  therefore  a  large  part  of  a  child's  early  edu- 
cation. If  careful  training  in  these  matters  is  begun 
at  the  outset  and  continued,  the  results  will  well  re- 
pay the  time  and  effort  required. 

Whether  the  child  feeds  himself  or  is  fed  by  the 
nurse,  the  following  rules  should  be  observed: 

1.  Food  at  regular  hours  only;  nothing  between 
meals. 

2.  Plenty  of  time  should  be  taken.  On  no  ac- 
count should  the  child  bolt  his  food. 

3.  The  child  must  be  taught  to  chew  his  food. 
Yet  no  matter  how  much  pains  are  taken  in  this 
respect,  mastication  is  very  imperfectly  done  by  all 
children;  hence  up  to  the  seventh  year  at  least,  all 


GENERAL  RULES  TO  BE  OBSERVED  IN  FEEDING  143 

meats  should  be  very  finely  cut,  all  vegetables  mashed 
to  a  pulp,  and  all  grains  cooked  very  soft. 

4.  Children  should  not  be  continually  urged  to 
eat  if  they  are  disinclined  to  do  so  at  their  regular 
hours  of  feeding,  or  if  the  appetite  is  habitually 
poor,  and  under  no  circumstances  should  a  child  be 
forced  to  eat. 

5.  Indigestible  food  should  never  be  given  to 
tempt  the  appetite  when  the  ordinary  simple  food  is 
refused;  food  should  not  be  allowed  between  meals 
because  it  is  refused  at  meal-time. 

6.  One  serious  objection  to  allowing  young  chil- 
dren highly  seasoned  food,  entrees,  jellies,  pastry, 
sweets,  etc.,  even  in  such  small  amounts  as  not  to 
upset  the  digestion,  is  that  children  thus  indulged 
soon  lose  appetite  for  the  simple  food  which  pre- 
viously was  taken  with  relish. 

7.  If  there  is  any  important  article  of  a  simple 
diet  such  as  milk,  meat,  cereals,  or  vegetables,  which 
a  child  habitually  refuses,  this  should  always  be 
given  first  at  the  meal  and  other  food  withheld 
until  it  is  disposed  of.  Children  so  readily  form 
habits  of  eating  only  certain  things  and  refusing 
others  that  such  an  inclination  should  be  checked 
early. 

8.  If  an  infant  refuses  its  food  altogether,  or 
takes  less  than  usual,  the  food  should  be  examined 


144       THE  CAKE  AND  FEEDING  OF  CHILDREN 

^ 

to  see  if  this  is  right.  Then  the  mouth  should  hj. 
inspected  to  see  if  it  is  sore.  If  neither  of  these 
things  is  the  cause,  the  food  should  be  taken  away 
and  not  offered  again  until  the  next  feeding  time 
comes. 

9.  In  any  acute  illness  the  amount  of  food  should 
he  much  reduced  and  the  food  made  more  dilute  than 
usual.  If  there  is  fever,  no  solid  food  should  be 
given.  If  the  child  is  already  upoiL  a  milk  diet,  this 
should  be  diluted,  and  in  some  cases  partially  pep- 
tonized. 

10.  In  very  hot  weather  the  same  rules  hold,  to 
give  less  food,  particularly  less  solid  food,  and  more 
water. 

FOOD  FORMULAS 

Beef  Juice. — One  pound  of  rare  round  steak,  cut 
thick,  slightly  broiled,  and  the  juice  pressed  out  by 
a  lemon-squeezer,  or,  better,  a  meat-press.  From 
two  to  four  ounces  of  juice  can  generally  be  ob- 
tained. This,  seasoned  with  salt,  may  be  given  cold, 
or  warmed  by  placing  the  cup  which  holds  it  in 
warm  water.  It  should  not  be  heated  sufficiently  to 
coagulate  the  albumin  which  is  in  solution,  and 
which  then  appears  as  flakes  of  meat  floating  in  the 
fluid. 


FOOD  FORMULAS  145 


Beef  Juice  hy  the  Cold  Process. — One  pound  of 
finely  chopped  round  steak,  six  ounces  of  cold  water, 
a  pinch  of  salt;  place  in  a  covered  jar  and  stand  on 
ice  or  in  a  cold  place,  five  or  six  hours  or  overnight. 
It  is  well  to  shake  occasionally.  This  is  now  strained 
and  all  the  juice  squeezed  out  by  placing  the  meat  in 
coarse  muslin  and  twisting  it  very  hard.  It  is  then 
seasoned  and  fed  like  the  above. 

Beef  juice  so  made  is  not  quite  as  palatable  as 
that  prepared  from  broiled  steak,  but  it  is  even  more 
nutritious,  and  is  more  economical,  as  fully  twice  as 
much  juice  can  be  obtained  from  a  given  quantity  of 
meat.  Beef  juice  prepared  in  either  of  these  ways 
is  greatly  to  be  preferred  to  the  beef  extracts  sold. 

Mutton  Broth. — One  pound  of  finely  chopped 
lean  mutton,  including  some  of  the  bone,  one  pint 
cold  water,  pinch  of  i4lt.  Cook  for  three  hours  over 
a  slow  fire  down  to  half  a  pint,  adding  water  if  neces- 
sary ;  strain  through  muslin,  and  when  cold  carefully 
remove  the  fat,  adding  more  salt  if  required.  It  may 
be  fed  warm,  or  cold  in  the  form  of  a  jelly. 

A  very  nutritious  and  delicious  broth  is  made  by 
thickening  this  with  cornstarch  or  arrowroot,  cook- 
ing for  ten  minutes  and  then  adding  three  ounces  of 
milk,  or  one  ounce  of  thin  cream,  to  a  half  pint  of 
broth. 


146       THE  CARE  AND  FEEDING  OF  CHILDREN 

ChicheUy  Veal,  and  Beef  Broths. — These  are 
made  and  used  in  precisely  the  same  manner  as  mut- 
ton broth. 

Scraped  Beef  or  Meat  Pulp. — A  rare  piece 
of  round  or  sirloin  steak,  the  outer  part  having  been 
cut  away,  is  scraped  or  shredded  with  a  knife;  one 
teaspoonful  to  one  tablespoonful  may  be  given,  well 
salted,  to  a  child  of  eighteen  months.  Scraping  is 
much  better  than  cutting  the  meat  fine. 

Tor  this  on  a  large  scale,  as  in  institutions,  a 
Hamburg-steak  cutter  may  be  employed. 

Junket,  or  Curds  and  Whey. — One  pint  of  fresh 
cow's  milk,  warmed;  pinch  of  salt;  a  teaspoonful  of 
granulated  sugar;  add  two  teaspoonfuls  of  Fair- 
child's  essence  of  pepsin,  or  liquid  rennet,  or  one 
junket  tablet  dissolved  in  water;  stir  for  a  moment, 
and  then  allow  it  to  stand  at  the  temperature  of  the 
room  for  twenty  minutes,  or  until  firmly  coagu- 
lated; place  in  the  ice  box  until  thoroughly  cold. 
For  older  children  this  may  be  seasoned  with  grated 
nutmeg. 

Whey. — The  coagulated  milk  prepared  as  above 
is  broken  up  with  a  fork  and  the  whey  strained  off 
through  muslin.  If  some  stimulant  is  desired, 
sherry  wine  in  the  proportion  of  one  part  to  twelve, 
or  brandy  one  part  to  twenty-four,  may  be  added. 


FOOD  FORMULAS  14T 


Whey   is   useful   in  many  cases   of   acute   indiges-^ 
tion. 

Barley  Water. — One  level  tablespoonful  of  Eob- 
inson's  patent  barley,  or  the  prepared  barley  flour  of 
the  Health  Food  Company,  is  thoroughly  blended 
with  a  little  cold  water  and  added,  stirring,  to  one 
pint  of  boiling  water  containing  a  pinch  of  salt.  This 
is  cooked  for  thirty  minutes  in  a  double  boiler  and 
then  strained.  As  much  boiled  water  should  then  be 
added  as  has  boiled  away. 

Barley  Gruel  or  Barley  Jelly. — This  is  made  in 
the  same  manner  as  the  above  but  from  two  to  four 
level  tablespoonfuls  of  the  flour  are  used. 

Either  barley  water  or  barley  jelly  may  be  made 
from  the  grains.  For  barley  water,  use  one  heaping 
tablespoonful  of  pearl  barley  which  has  been  soaked 
four  or  five  hours,  or  overnight,  one  pint  of  water,  a 
pinch  of  salt.  This  is  boiled  steadily  for  four  hours, 
adding  water  from  time  to  time  to  keep  the  quantity 
up  to  one  pint.     It  is  then  strained  through  muslin. 

For  barley  gruel  or  barley  jelly  use  from  two  to 
four  tablespoonfuls  of  pearl  barley. 

Ricey   Wheat,  or  Oat  Water. — These  are  made 

from  rice,  wheat,  or  oat  flour  exactly  as  barley  water^ 

above  described.    Like  the  barley  water  they  may  also 

be  made  from  the  grains  using  the  same  proportions. 
10 


148       THE  CARE  AND  FEEDING  OF  CHILDREN 

Gruel  or  Jelly  from  :Rice,  Wheat,  or  Oats. — 
These  are  made  from  the  flours  or  grains  as  has  been 
described  for  barley  gruel. 

For  the  wheat  preparations,  ordinary  wheat  flour 
may  be  used  or  HubbelFs  prepared  wheat  flour;  or 
wheaten  grits  may  be  employed. 

For  the  rice  preparations  the  ordinary  rice  grains 
or  rice  flour  may  be  used. 

For  the  oat  preparations,  either  the  oat  flour  of 
the  Health  Food  Company  may  be  used,  or  any  of 
the  commonly  employed  forms  of  oatmeal. 

When  any  of  these  farinaceous  foods  are  to  be 
mixed  with  milk,  the  milk  should  be  added  directly 
after  removing  the  gruel  from  the  fire,  and  stirred 
two  or  three  minutes. 

Imperial  Granum. — This  is  prepared  and  used 
in  precisely  the  same  way  as  the  barley  flour  above 
mentioned. 

Albumin  Water. — The  white  of  one  fresh  egg-, 
half  a  pint  of  cold  water ;  pinch  of  salt ;  teaspoonf ul 
of  brandy.  This  should  be  shaken  thoroughly  and 
fed  cold  either  with  a  spoon  or  from  a  bottle.  It  is 
useful  in  cases  of  vomiting,  and  can  sometimes  be 
retained  by  a  very  irritable  stomach. 

Lime-Water. — One  heaping  teaspoonful  of  slaked 
Jime ;  one  quart  boiled  or  distilled  water ;  place  in  a 


FOOD  FORMULAS  149 


corked  bottle  and  shake  thoroughly  two  or  three 
times  during  the  first  hour.  The  lime  should  then 
be  allowed  to  settle,  and  after  twenty-four  hours  the 
upper  clear  fluid  carefully  poured  or  siphoned  off 
for  use. 

Dried  Bread. — Either  stale  or  fresh  bread  may 
be  used ;  it  is  cut  in  thin  slices  and  placed  in  the 
oven,  with  the  door  open,  and  quickly  dried  until 
it  is  crisp,  but  not  browned.  It  is  in  many  respects 
preferable  to  crackers  for  little  children. 

Coddled  Egg. — A  fresh  egg,  shell  on,  is  placed  in 
boiling  water  which  is  immediately  after  removed 
from  the  fire.  The  egg  then  cooks  slowly  in  the 
water,  which  gradually  cools,  for  seven  or  eight  min- 
utes, when  the  white  should  be  about  the  consistency 
of  jelly.  For  a  delicate  digestion  the  white  only 
should  be  given,  with  salt ;  it  can  be  easily  separated 
from  the  yolk. 


PAET  IV 
MISCELLANEOUS 


IV 
MISCELLANEOUS 

THE    BOWELS 

How  many  movements  daily  should  an  infant 
have  during  the  first  few  weeks  of  life? 

Usually  two  or  three  a  day  for  the  first  week, 
and  then  one  or  two  each  day. 

How  many  after  a  child  is  a  month  old? 

A  healthy  child  should  have  at  least  one  move- 
ment each  day;  many  have  two  and  some  more  than 
two ;  but  it  is  the  character  of  the  stools  rather  than 
their  number  which  is  to  be  taken  as  the  evidence 
of  perfect  digestion. 

What  is  the  appearance  of  a  healthy  movement 
of  a  child  who  is  taking  nothing  hut  milk? 

It  is  soft,  yellow,  and  smooth,  containing  no 
lumps. 

When  are  the  stools  dark  brown  or  hlack? 
While  taking  bismuth,  iron,  and  sometimes  when 
taking  much  meat  or  beef  juice;  also  while  taking 
153 


154       THE  CARE  AND  FEEDING   OF  CHILDREN 

many  of  the  prepared  foods.  They  may  be  dark 
brown  or  black  from  blood.  This  last  is  a  condition 
which  may  indicate  serious  illness. 

How  may  a  child  he  trained  to  he  regular  in  the 
action  of  its  howels? 

By  endeavouring  to  have  them  move  at  exactly 
the  same  time  every  day. 

At  what  age  may  an  infant  he  trained  in  this 


Usually  by  the  second  month  if  training  is  begun 
early. 

What  is  the  hest  method  of  training? 

A  small  chamber,  about  the  size  of  a  pint  bowl, 
is  placed  between  the  nurse's  knees,  and  upon  this 
the  infant  is  held,  its  back  being  against  the  nurse's 
chest  and  its  body  firmly  supported.  This  should  be 
done  twice  a  day,  after  the  morning  and  afternoon 
feedings,  and  always  at  the  same  hour.  At  first  there 
may  be  necessary  some  local  irritation,  like  that  pro- 
duced by  tickling  the  anus  or  introducing  just  inside 
the  rectum  a  small  cone  of  oiled  paper  or  a  piece  of 
soap,  as  a  suggestion  of  the  purpose  for  which  the 
baby  is  placed  upon  the  chamber;  but  in  a  surpris- 
ingly short  time  the  position  is  all  that  is  required. 
With  most  infants,  after  a  few  weeks  the  bowels  will 
move  as  soon  as  the  infant  is  placed  on  the  chamber. 


SLEEP  155 


What  advantage  has  such  training? 

It  forms  the  habit  of  having  the  bowels  move 
regularly  at  the  same  hour,  which  is  a  matter  of 
great  importance  in  infancy  and  makes  regularity 
in  childhood  much  easier.  It  also  saves  the  nurse 
much  trouble  and  labour. 

SLEEP 

Should  a  child  sleep  in  the  same  hed  with  Us 
mother  or  nurse  f 

Under  no  circimistances,  if  this  can  possibly  be 
avoided.  Very  young  infants  have  often  been  smoth- 
ered by  their  mothers,  by  overlying  during  sleep.  If 
the  infant  sleeps  with  the  mother,  there  is  always  the 
temptation  to  frequent  nursing  at  night,  which  is  in- 
jurious to  both  mother  and  child.  Older  children 
also  should,  if  possible,  have  separate  beds;  many 
contagious  diseases  and  bad  habits  are  contracted  by 
children  sleeping  together. 

How  should  an  infant's  hed  he  prepared? 

The  mattress  should  be  firm  but  soft,  the  pillow 
very  thin,  and  the  covering  not  excessive.  A  baby 
should  not  be  allowed  to  sleep  always  in  the  sam© 
position,  but  should  be  changed  from  side  to  side. 
Hair  pillows  are  useful  in  summer  and  for  children 
who  perspire  very  niuch. 


156       THE  CARE  AND  FEEDING  OF  CIlILDItEN 

How  much  sleep  is  ^natural  for  a  newly  horn 
hahy? 

A  baby  with  a  good  digestion  and  proper  food 
will  usually  sleep  at  this  period  about  nine  tenths 
of  the  time. 

How  much  should  a  hahy  sleep  at  six  months? 
About  two  thirds  of  the  time. 

Up  to  what  age  should  an  older  child  take  a  nap 
during  the  day? 

Always  until  four  years  old,  and  if  possible 
longer. 

At  what  age  may  an  infant  go  all  night  without 
feeding? 

At  five  months  a  child  should  not  be  fed  or 
nursed  between  10  p.  m.  and  6  a.  m.  At  two  years 
a  child  can  easily  go  from  6  p.  m.  to  6  a.  m.  without 
feeding. 

How  should  a  hahy  he  put  to  sleep  ? 

The  room  should  be  darkened  and  quiet,  the 
child's  hunger  satisfied,  and  the  child  made  gen- 
erally comfortable  and  laid  in  its  crib  while 
awake. 

7s  rocking  necessary? 

By  no  means.  It  is  a  habit  easily  acquired,  but 
hard  to  break,  and  a  very  useless  and  sometimes  in- 


SLEEP  157 

jurious  one.  The  same  may  be  said  of  sucking  a 
rubber  nipple,  or  "pacifier/'  and  all  other  devices 
for  putting  children  to  sleep. 

What  are  the  principal  causes  of  disturbed 
sleep  ? 

As  quiet  peaceful  sleep  is  a  sign  of  perfect 
health,  disorders  of  sleep  may  be  produced  by  al- 
most anything  which  is  wrong  with  the  child. 

1.  Habitual  disturbance  of  sleep  in  infants  is 
most  frequently  associated  with  the  food  or  feeding. 
It  may  be  from  the  discomfort  of  chronic  indigestion 
due  to  improper  food.  In  bottle-fed  infants  it  is 
often  the  result  of  overfeeding;  in  those  who  are 
nursed  it  is  often  due  to  hunger.  A  common  cause 
is  frequent  night  feeding ;  an  infant  who  is  fed  three 
or  four  times  during  the  night  is  almost  invariably 
a  bad  sleeper. 

2.  Disturbed  sleep  or  sleeplessness  may  be  due 
to  causes  purely  nervous.  Such  are  bad  habits  ac- 
quired by  faulty  training;  as  when  the  nursery  is 
lighted  and  the  child  taken  from  its  crib  whenever 
it  wakes  or  cries;  or  when  some  of  the  contrivances 
for  inducing  sleep  have  been  used.  Any  excitement 
or  romping  play  just  before  bedtime,  and  fears 
aroused  by  pictures  or  stories,  are  frequent  causes. 
Children  who  inherit  from  their  parents  a  nervous 


158       THE   CARE  AND  FEEDING  OF  CHILDREN 

constitution    are    especially    likely    to    suffer    thus. 

3.  There  may  be  physical  discomfort  from  cold 
feet,  insufficient  or  too  much  clothing,  or  want  of 
fresh  air  in  the  sleeping  room. 

4.  Interference  with  breathing  due  to  obstruc- 
tion from  large  tonsils  or  adenoids.  These  cause 
great  restlessness  and  lead  a  child  to  assume  many 
different  postures  during  sleep,  often  lying  upon  the 
face  or  upon  the  hands  and  knees. 

5.  Chronic  pains  or  frequently  recurring  night 
pains  may  be  causes  of  disordered  sleep,  when  a  child 
wakes  with  a  sudden  sharp  cry.  In  infants  this  is 
most  often  due  to  scurvy,  sometimes  to  syphilis.  In 
older  children  it  may  be  the  earliest  symptom  of  dis- 
ease of  the  hip  or  spine. 

6.  Sleeplessness  and  disturbed  sleep  are  frequent 
whenever  the  general  condition  falls  much  below  a 
healthy  standard ;  e.  g.,  in  infants  who  are  not  thriv- 
ing and  in  children  suffering  from  marked  anaemia. 

How  are  children  who  sleep  too  little,  or  whose 
sleep  is  constantly  disturbed,  to  he  treated? 

ITever  by  the  use  of  soothing  sirups  or  other 
medicines.  Successful  treatment  consists  in  the  dis- 
covery and  removal  of  the  cause. 

Do  children  ever  sleep  too  much? 

It  is  doubtful  if  healthy  children  ever  do.     Ex- 


EXERCISE  159 

cessive  sleep  is  an  important  symptom  of  some  dis- 
eases of  the  brain.  Otherwise  it  seldom  if  ever  oc- 
curs unless  soothing  sirups  or  other  drugs  have  been 
given. 

EXERCISE 

7s  exercise  important  for  infants? 

It  is  as  necessary  for  them  as  for  older  children. 

How  is  it  obtained? 

A  young  baby  gets  its  exercise  by  screaming, 
waving  its  arms,  kicking,  etc.  The  clothing  should 
not  be  so  tight  as  to  make  these  movements  impos- 
sible. At  least  twice  a  day  the  infant  should  be 
allowed  for  fifteen  or  twenty  minutes  the  free  use  of 
its  limbs  by  permitting  it  to  lie  upon  a  bed  in  a 
warm  room,  with  all  clothing  except  the  shirt,  stock- 
ings, and  napkin  removed.  Later,  when  in  short 
clothes,  the  baby  may  be  put  upon  a  thick  blanket 
or  quilt  laid  upon  the  floor,  and  be  allowed  to  tumble 
about  at  will.  A  nursery  fence  two  feet  high,  made 
to  surround  a  mattress,  is  an  excellent  device  and 
makes  a  convenient  box  stall  for  the  young  animal, 
where  it  .can  learn  to  use  both  its  arms  and  legs  with- 
out the  danger  of  injury.  Only  by  exercise  such  as 
this  do  the  muscles  have  an  opportunity  to  develop 
properly. 


160        THE  CARE  AND  FEEDING   OF  CHILDREN 


THE    CEY 

When  is  crying  useful? 

In  the  newly  born  infant  the  cry  expands  the 
lungs,  and  it  is  necessary  that  it  should  be  repeated 
for  a  few  minutes  every  day  in  order  to  keep  them 
well  expanded. 

How  much  crying  is  normal  for  a  very  young 
hahy? 

From  fifteen  to  thirty  minutes  a  day  is  not  too 
much. 

What  is  the  nature  of  this  cry? 

It  is  loud  and  strong.  Infants  get  red  in  the 
face  with  it;  in  fact,  it  is  a  scream.  This  is  neces- 
sary for  health.     It  is  the  baby's  exercise. 

When  is  a  cry  abnormal? 

When  it  is  too  long  or  too  frequent.  The  ab- 
normal cry  is  rarely  strong,  often  it  is  a  moan- 
ing or  a  worrying  cry,  sometimes  only  a  feeble 
whine. 

What  are  the  causes  of  such  crying? 
Pain,  temper,  hunger,  illness,  and  habit. 

.What  is  the  cry  of  pain? 

It  is  usually  strong  and  sharp,  but  not  generally 
continuous.    It  is  accompanied  by  contraction  of  the 


THE  CRY  161 


features,  drawing  up  of  the  legs,  and  other  symptoms 
of  distress. 

What  is  the  cry  of  hunger? 
It  is  usually  a  continuous,   fretful  cry,  rarely 
strong  and  lusty. 

What  is  the  cry  of  temper? 

It  is  loud  and  strong  and  accompanied  by  kick- 
ing or  stiffening  of  the  body,  and  is  usually  violent. 

What  is  the  cry  of  illness? 

There  is  usually  more  of  f retfulness  and  moaning 
than  real  crying,  although  crying  is  excited  by  very 
slight  causes. 

What  is  the  cry  of  indulgence  or  from  habit  ? 

This  is  often  heard  even  in  very  young  infants, 
who  cry  to  be  rocked,  to  be  carried  about,  sometimes 
for  a  light  in  the  room,  for  a  bottle  to  suck,  or  for 
the  continuance  of  any  other  bad  habit  which  has 
been  acquired. 

Hoia  can  we  he  sure  that  a  child  is  crying  to  he 
indulged  f 

If  it  stops  immediately  when  it  gets  what  it 
wants,  and  cries  when  it  is  withdrawn  or  withheld. 

What  should  he  done  if  a  hahy  cries  at  night  ?  ' 
One  shouJd  get  up  and  see  that  the  child  is  com- 


163       THE  CARE  AND  FEEDING  OP  CHILDREN 

fortable — the  clothing  smooth  under  the  body,  the 
hands  and  feet  warm,  and  the  napkin  not  wet  or 
soiled.  If  all  these  matters  are  properly  adjusted 
and  the  child  simply  crying  to  be  taken  up,  it  should 
not  be  further  interfered  with.  If  the  night  cry  is 
habitual  some  other  cause  should  be  sought  (see 
page  118). 

How  is  an  infant  to  he  managed  that  cries  from 
temper,  hahit,  or  to  he  indulged? 

It  should  simply  be  allowed  to  "  cry  it  out." 
This  often  requires  an  hour,  and  in  extreme  cases, 
two  or  three  hours.  A  second  struggle  will  seldom 
last  more  than  ten  or  fifteen  minutes,  and  a  third 
will  rarely  be  necessary.  Such  discipline  is  not  to 
be  carried  out  unless  one  is  sure  as  to  the  cause  of 
the  habitual  crying. 

Is  it  nicely  that  rupture  will  he  caused  from  cry- 
ing? 

]^ot  in  young  infants  if  the  abdominal  band  is 
properly  applied,  and  not  after  a  year  under  any 
circumstances. 

LIFTITTG    CHrLDREN 

How  should  a  young  hahy  he  lifted  from  its  hedf 

The  right  hand  should  grasp  the  clothing  below 

the  feet,  and  the  left  hand  should  be  slipped  beneath 


THE   TEMPERATURE  163 

t 

the  infant's  body  to  its  head.     It  is  then  raised  upon 
the  left  arm. 

What  is  the  advantage  of  this? 

The  entire  spine  is  supported,  and  no  undue  pres- 
sure is  made  upon  the  chest  or  abdomen,  as  often 
happens  if  the  baby  is  grasped  around  the  body  or 
under  the  arms. 

How  should  a  child  old  enough  to  run  about  he 
lifted? 

Always  by  placing  the  hands  under  the  child's 
arms,  and  never  by  the  wrists. 

What  injury  may  he  inflicted  hy  lifting  the  child 
hy  the  wrists  or  hands? 

Often  serious  injury  is  done  to  the  elbow  or 
shoulder  joints. 

THE    TEMPEEATUKE 

What  is  the  normal  temperature  of  an  infant? 

The  normal  temperature  varies  more  than  in 
adults.  In  the  rectum  it  usually  fluctuates  between 
98^  and  99.6°  F. ;  a  rectal  temperature  of  97.5°  F. 
or  of  100;  5°  F.  is  of  no  importance  whatever  un- 
less it  continues. 

Where  should  the  temperature   of  infants  and 
young  children  he  tahen? 
11 


164       THE  CARE  AND  FEEDING   OF  CHILDREN 

The  rectum  is  altogether  the  best  place,  and  next 
to  this  the  groin.  The  rectal  temperature  is  from 
half  a  degree  to  a  degree  higher  than  that  in  the 
groin. 

How  long  should  the  thermometer  he  left  in 
place  to  take  the  temperature? 

Two  minutes  in  the  rectum,  and  five  minutes  in 
the  groin. 

Is  the  temperature  of  a  young  child  a  good  guide 
as  to  the  severity  of  its  symptoms  in  illness? 

As  a  rule  it  is.  A  temperature  of  100°  to  102° 
F.  commonly  means  a  mild  illness,  and  one  of  104° 
F.  or  over  a  serious  one.  The  duration  of  the  fever 
is,  however,  even  more  important  than  the  height  of 
the  temperature.  It  should  be  remembered  that  in 
all  young  children  slight  causes  often  produce  a  high 
temperature  which  lasts  for  a  few  hours ;  one  should 
not  therefore  be  unduly  alarmed  unless  the  tempera- 
ture continues  high,  or  is  accompanied  by  other  im- 
portant signs  of  illness. 

Is  not  a  high  temperature  a  more  serious  symp- 
tom in  a  young  child  than  in  an  adult? 

The  opposite  is  rather  the  case.  Young  children 
are  extremely  sensitive  to  conditions  which  produce 
fever,  and  the  thermometer  often  gives  an  exagger- 
ated idea  of  the  severity  of  the  symptoms.     A  cause 


NERVOUSNESS  165 


which  in  an  adult  might  produce  a  temperature  of 
102°  F.  or  103°  F.,  in  a  young  child  would  very 
likely  be  accompanied  by  a  temperature  of  104°  or 
105°  F. 

NERVOUSNESS 

What  are  the  principal  causes  of  excessive  nerv- 
ousness in  infants  and  young  children,  and  what  can 
he  done  to  prevent  this? 

The  most  important  cause  is  the  delicate  struc- 
ture of  the  brain  at  this  time,  and  its  rapid  growth. 
It  grows  as  much  during  the  first  year  as  during  all 
the  rest  of  life.  This  requires  quiet  and  peaceful 
surroundings.  Infants  who  are  naturally  nervous 
should  be  left  much  alone,  should  see  but  few  people, 
should  be  played  with  very  little,  and  should  never 
be  quieted  with  soothing  sirups  or  the  "  pacifier." 

At  what  age  may  playing  with  hahies  he  hegun? 

Babies  under  six  months  old  should  never  be 
played  with;  and  the  less  of  it  at  any  time  the  bet- 
ter for  the  infant. 

What  harm  is  done  hy  playing  with  very  young 
hahies? 

They  are  made  nervous  and  irritable,  sleep  bad- 
ly, and  suffer  from  indigestion  and  in  many  other 
respects. 


166       THE  CARE  AND  FEEDING  OF  CHILDREN 

When  may  young  children  he  played  with? 
If  at  all,  in  the  morning,  or  after  the  midday 
nap;  but  never  just  before  bedtime. 

TOYS 

What  points  should  guide  one  in  selecting  toys 
and  playthings  for  an  infant? 

The  instinct  in  a  baby  to  put  everything  into  the 
mouth  is  so  strong  that  nothing  should  be  given  that 
cannot  be  safely  treated  in  this  way.  Hence  one 
should  choose  things  which  are  smooth,  those  which 
can  be  easily  washed,  and  those  which  cannot  be 
swallowed. 

One  should  avoid  (1)  toys  with  sharp  points  or 
corners;  (2)  those  with  loose  parts  that  might  be  de- 
tached or  broken  off  and  swallowed;  (3)  small  ob- 
jects which  might  be  swallowed  or  pushed  into  the 
nose  or  ear,  such  as  coins,  marbles,  and  safety-pios, 
also  beads  and  buttons  unless  strung  upon  a  stout 
cord;  (4)  painted  toys;  (5)  those  covered  with  hair 
or  wool.  Infants  have  often  been  severely  injured 
by  swallowing  what  they  have  pulled  off  from  their 
small  toy  animals. 

What  points  are  to  he  considered  in  selecting  the 

toys  and  playthings  of  a  child  over  two  years  old? 

It  should  be  remembered  that  toys  are  not  mere- 


TOYS  167 

ly  a  source  of  amusement,  but  that  they  have  an 
educational  value  as  well.  Those  are  therefore  to 
be  preferred  the  use  of  which  develops  the  child's 
imagination,  and  with  which  he  can  be  taught  to 
amuse  himself.  For  boys  nothing  can  surpass  blocks, 
toy  soldiers,  balls,  engines,  and  cars;  and  for  girls, 
dolls  and  housekeeping  sets.  The  complicated  Ine- 
chanical  toys  now  so  much  in  vogue  give  only  a 
momentary  pleasure,  and  as  soon  as  the  wonder  at 
their  operation  has  worn  off,  they  have  lost  interest 
for  the  child  except  that  which  he  gets  in  breaking 
them  to  see  how  the  thing  worked. 

What  important  things  can  he  taught  children 
with  their  toys  and  how  may  this  he  done? 

The  imagination  may  be  developed,  and  children 
may  be  trained  to  habits  of  neatness,  order  and  regu- 
larity, and  to  concentration  of  mind. 

To  this  end  toys  should  be  kept  in  an  orderly 
way  upon  a  shelf  in  the  nursery  or  in  a  closet,  never 
piled  in  a  miscellaneous  heap  in  the  corner  of  the 
room.  Children  should  select  their  toys  and  play 
with  one  thing  at  a  time,  which  they  should  be  taught 
to  put  away  in  its  place  before  another  is  given. 
They  should  never  be  allowed  to  have  a  dozen  things 
strewn  about  the  room  at  one  time,  with  none  of 
which  they  are  occupied. 


168       THE  CARE  AND  FEEDING  OF  CHILDREN 


KISSIKG 

Are  there  any  valid  objections  to  kissing  in- 
fants? 

There  are  many  serious  objections.  Tuberculo- 
sis, diphtheria,  and  many  other  grave  diseases  may 
be  communicated  in  this  way.  The  kissing  of  in- 
fants upon  the  mouth  by  other  children,  by  nurses,  or 
by  people  generally,  should  under  no  circumstances 
be  permitted.  Infants  should  be  kissed,  if  at  all, 
upon  the  cheek  or  forehead,  but  the  less  even  of  this 
the  better. 

CONVULSIONS 

What  should  he  done  for  a  child  in  convulsions 
before  a  doctor  arrives  f 

Keep  the  child  perfectly  quiet  with  ice  at  the 
head,  put  the  feet  in  a  mustard  bath,  and  roll  the 
entire  body  in  large  towels  which  have  been  dipped 
in  mustard  water  (two  heaping  tablespoonfuls  of 
mustard  to  one  quart  of  tepid  water),  and  have 
plenty  of  hot  water  and  a  bath  tub  at  hand,  so  that 
the  doctor  can  give  a  hot  bath  if  he  thinks  it  advis- 
able. 

When  is  a  hot  bath  useful? 

If  the  convulsions  have  continued  until  the  pulse 
is  weak,  the  face  very  pale,  the  nails  and  lips  blue, 


FOREIGN  BODIES  169 

and  the  feet  and  hands  cold,  the  hot  bath  will  be 
useful  by  bringing  blood  to  the  surface  and  relieving 
the  heart,  lungs,  and  brain. 

How  should  the  hath  he  given? 

The  temperature  should  not  be  over  106°  F. ; 
this  should  always  be  tested  by  a  thermometer  if  one 
can  be  obtained.  Without  this  precaution,  in  the  ex- 
citement of  the  moment,  infants  have  frequently 
been  put  into  baths  so  hot  that  serious  and  even  fatal 
burns  have  been  produced.  If  no  thermometer  is 
available  the  nurse  may  plunge  her  arm  to  the  elbow 
into  the  water.  It  should  feel  warm,  but  not  so  hot 
as  to  be  at  all  uncomfortable.  One  half  a  teacupful 
of  powdered  mustard  added  to  the  bath  often  adds 
to  its  efficacy. 

FOEEIGlSr    BODIES 

What  should  he  done  if  a  foreign  hody  has  been 
swallowed? 

First,  examine  the  throat  with  the  finger.  If  it 
has  lodged  there  remove  it.  If  it  has  passed  from  the 
throat  it  has  usually  gone  into  the  stomach.  Next  be 
sure  that  the  thing  has  actually  been  swallowed. 
Often  needless  alarm  is  allayed  by  finding  in  the 
child's  crib  or  elsewhere  the  thing  supposed  to  have 
been  swallowed.  The  stools  should  be  examined  daily 
to  see  if  the  foreign  body  passes  the  bowel. 


170       THE  CARE  AND  FEEDING  OF  CHILDREN 

What  further  treatment  is  needed? 

Give  the  child  plenty  of  dry  food,  like  bread,  po- 
tato, etc.,  but  under  no  circumstances  either  an  emet- 
ic or  cathartic.     An  infant  may  have  its  usual  food. 

What  harm  would  a  cathartic  do  ? 

It  is  likely  to  hurry  the  foreign  body  too  rapidly 
through  the  intestine  and  in  this  way  do  harm ;  other- 
wise it  becomes  coated  with  faecal  matter  and  passes 
the  intestine  usually  without  doing  injury. 

What  should  he  done  if  a  child  gets  a  foreign 
body  into  the  ear? 

IJnless  this  can  easily  be  removed  with  the  fin- 
gers it  should  not  be  meddled  with,  for  it  is  likely  to 
be  pushed  farther  into  the  ear.  The  child  should  be 
taken  to  a  physician. 

What  should  he  done  if  there  is  a  foreign  hody 
in  the  nose? 

The  child  should  blow  his  nose  strongly  while 
the  empty  nostril  is  compressed.  Unless  this  re- 
moves it  a  physician  should  be  called.  Meddlesome 
interference  is  always  harmful. 

COLIC 

What  are  the  symptoms  of  colic? 
There  is  a  strong,  hard  cry,  which  comes  sud- 
denly and  returns  every  few  minutes.     With  this 


EARACHE  171 


there  is  drawing  up  of  the  feet,  contraction  of  the 
muscles  of  the  face,  and  other  signs  of  pain.  The 
abdomen  is  usually  tense  and  hard. 

What  should  he  done  for  a  hdby  with  colic? 

First,  see  that  the  feet  are  warm.  Place  them 
against  a  hot-water  bag,  or  hold  them  before  an  open 
fire;  apply  a  hot  flannel  to  the  abdomen,  or  let  the 
child  lie  upon  its  stomach  across  a  hot-water  bag. 
If  the  colic  continues,  a  half  teacupful  of  warm 
water  containing  ten  drops  of  turpentine  may  be  in- 
jected into  the  bowels  with  a  syringe;  at  the  same 
time  the  abdomen  should  be  gently  rubbed  so  as  to 
start  the  wind.  If  the  gas  is  in  the  stomach,  half  of 
a  soda  mint  tablet  may  be  given  in  a  tablespoonful 
of  very  warm  water. 

EARACHE 

What  are  the  symptoms  of  earache? 

The  pain  is  generally  severe  and  accompanied  by 
a  sharp  scream ;  the  child  often  puts  the  hand  to  the 
affected  ear,  or  cries  whenever  it  is  touched.  The 
pain  is  likely  to  be  prolonged  and  continuous. 

Hoiu  should  a  child  with  earache  he  treated? 

The  ear  should  be  irrigated  with  a  solution  of 
boric  acid  (twenty  grains  to  the  ounce)  as  warm  as 
can  be  borne.    Dry  heat  may  then  be  applied  in  sev- 


172       THE  CARE  AND  FEEDING  OF  CHILDREN 

eral  ways.  The  ear  having  been  first  covered  with 
cotton,  a  small  hot-water  bag  or  one  filled  with  hot 
salt  or  bran,  may  be  bound  over  it  with  a  bandage ;  or 
a  small  butter  plate  heated  in  hot  water  may  be  used 
in  the  same  way.  The  hot-water  bag  may  be  held 
against  the  ear  or  the  child  may  lie  with  his  head 
upon  it.  The  use  of  such  substances  as  oil  and  lau- 
danum in  the  ear  is  not  to  be  recommended. 

CBOTJP 

What  are  the  symptoms  of  croup? 
There  is  a  hollow,  dry,  barking  cough,  with  some 
difficulty  in  breathing. 

When  is  this  likely  to  come  on? 
Usually  at  night. 

Is  simple  croup  dangerous? 

The  ordinary  croup  of  infants  is  spasmodic 
croup,  and  is  very  rarely  dangerous,  although  the 
symptoms  seem  very  alarming. 

What  are  the  symptoms? 

In  a  mild  attack  there  is  simply  noisy  breathing, 
especially  on  drawing  in  the  breath,  with  a  tight, 
barking,  or  croupy  cough.  In  a  severe  attack  the 
child's  breathing  is  more  noisy  and  be^-omes  diffi- 
cult. 


CONTAGIOUS  DISEASES  173 

What  is  the  dangerous  form  of  croup  f 
Membranous  croup,  which  is  the  same  thing  as 
diphtheria  of  the  larynx. 

How  does  this  develop? 

Gradually;  very  rarely  does  it  come  on  sud- 
denly. 

What  should  he  done  for  a  hahy  who  has  spas- 
modic croup? 

The  room  should  be  very  warm,  hot  cloths  or  poul- 
tices should  be  applied  over  the  throat,  and  either  a 
croup  kettle  or  an  ordinary  tea-kettle  kept  boiling  in 
the  room.  This  is  more  efficacious  if  the  child  is 
placed  in  a  tent  made  by  a  raised  umbrella  with  a 
sheet  thrown  over  it,  and  the  steam  introduced  be- 
neath the  tent.  If  the  symptoms  are  urgent,  ten 
drops  of  the  sirup  of  ipecac  should  be  given  every 
fifteen  minutes  until  free  vomiting  occurs.  When- 
ever the  symptoms  reach  a  point  where  breathing  be- 
comes difficult,  a  doctor  should  be  summoned  without 
delay. 

CONTAGIOUS    DISEASES 

What  are  the  first  symptoms  of  measles? 

Measles  comes  on  rather  gradually  with  cough, 
sneezing,  watery  eyes  and  nose,  much  like  an  ordi- 
nary cold  in  the  head.     The  eruption  appears  after 


174       THE  CARE  AND  FEEDING  OP  CHILDREN 

three  or  four  days,  first  upon  the  face  and  neck  as 
small  red  spots,  and  spreads  slowly  over  the  body. 

7s  measles  a  serious  disease'^ 

In  infants  and  during  the  winter  season  it  is 
likely  to  be  very  serious  on  account  of  the  danger 
of  bronchitis  and  pneumonia,  which  frequently  ac- 
company it.  In  children  over  four  years  old  it  is 
generally  not  severe.  No  child  should  be  voluntarily 
exposed  to  this  disease,  and  particularly  one  who  is 
delicate  or  prone  to  disease  of  the  lungs  should  be 
protected  against  it. 

When  and  how  is  measles  contagious? 

Measles  may  readily  be  conveyed  from  the  very 
beginning  of  the  catarrh,  two  or  three  days  before 
any  eruption  is  present.  It  is  not  often  carried  by 
healthy  persons.  Its  poison  does  not  cling  long  to 
a  sick  room. 

What  is  German  measles? 

German  measles,  or  rubella,  is  a  distinct  disease 
and  has  nothing  to  do  with  ordinary  measles.  It  is 
extremely  rare  for  a  child  to  be  much  sick  with  it. 
There  is  usually  a  very  extensive  eruption  which 
may  cover  the  body,  but  few  other  symptoms. 

What  are  the  first  symptoms  of  scarlet  fever? 
Generally  it  comes  suddenly,  with  vomiting,  high 


CONTAGIOUS  DISEASES  175 

fever,  and  sore  throat.  The  eruption  usually  ap- 
pears within  twenty-four  hours  as  a  red  blush,  first 
upon  the  neck  and  chest,  and  spreads  rapidly. 

When  and  how  is  scarlet  fever  contagious? 

Scarlet  fever  is  only  slightly  contagious  for  the 
first  one  or  two  days  of  the  attack.  It  is  most  con- 
tagious at  the  height  of  the  disease  and  during 
desquamation.  It  may  be  carried  by  healthy  persons 
and  by  the  clothing  or  bedding  from  the  sick  room. 

How  does  whooping-cough  begin? 

For  a  week  or  ten  days  it  cannot  be  distinguished 
from  an  ordinary  cold  on  the  chest.  Then  the  attacks 
of  coughing  gradually  become  more  severe  and  vom- 
iting may  follow.  After  a  severe  coughing  fit  the 
breath  is  caught  with  a  peculiar  noise  known  as  the 
"  whoop." 

How  does  chicken-pox  begin? 

It  usually  comes  out  gradually,  as  widely  scat- 
tered pimples  over  the  scalp,  face,  and  body,  many 
of  which  soon  become  small  vesicles,  resembling  tiny 
blisters.  There  is  itching  and  local  discomfort  but 
little  fever,  and  the  child  rarely  seems  to  be  very  ill. 

How  does  diphtheria  begin? 
Sometimes  suddenly,  but  usually  gradually,  with 
sore  throat  and  swelling  of  the  glands  of  the  neck, 


176       THE  CAEE  AND  FEEDING  OF  CHILDREN 

with  white  patches  upon  the  tonsils,  or  a  free  dis- 
charge, which  maj  be  bloody,  from  the  nostrils. 

How  does  mumps  begin? 

As  a  swelling  upon  the  jaw,  beneath  the  ear.  As 
it  increases  it  extends  forward  upon  the  cheek  and 
backward  behind  the  ear.    It  affects  one  or  both  sides. 

Mumps  is  not  very  common  in  young  children, 
and  in  them  it  is  usually  mild.  After  twelve  or 
thirteen  years  it  is  likely  to  be  more  severe. 

How  long  after  exposure  do  the  first  symptoms 
appear  in  the  different  diseases? 

In  scarlet  fever  in  from  three  to  -Q.ve  days,  rarely 
later  than  a  week ;  in  measles  in  from  nine  to  fourteen 
days,  occasionally  as  late  as  twenty  days;  in  whoop- 
ing-cough in  from  one  to  two  weeks ;  in  chicken-pox 
in  from  fourteen  to  sixteen  days ;  in  German  measles 
in  from  ten  to  sixteen  days.  In  diphtheria  the  time 
varies  much ;  it  may  be  only  one  day,  and  it  may  be 
one  or  two  weeks.  In  mumps  it  is  usually  a  little 
less  than  three  weeks,  the  average  being  twenty  days. 

Which  of  these  diseases  are  most  contagious? 

Measles  and  chicken-pox  are  very  contagious,  and 
very  few  children  who  have  not  had  them  can  come 
near  a  person  suffering  from  either  disease  without 
taking  it.  Whooping-cough  is  almost  as  contagious 
as  measles,  and  for  young  babies  even  more  so.     A 


CONTAGIOUS  DISEASES  177 


very  close  exposure  is  not  necessary  in  the  case  of 
either  of  these  diseases,  and  whooping-congh  can 
undoubtedly  be  contracted  in  the  open  air.  Scarlet 
fever  and  diphtheria  are  much  less  contagious;  for 
both  of  these  a  pretty  close  exposure  is  necessary. 

How  long  should  a  child  with  any  of  these  dis- 
eases he  kept  away  from  other  children? 

With  measles,  for  two  weeks  after  the  rash  has 
gone ;  with  scarlet  fever,  for  at  least  four  weeks  after 
the  rash  has  gone,  and  longer  if  the  peeling  is  not 
over  or  if  the  ears  are  running;  with  whooping- 
cough,  for  two  months,  or  so  long  as  the  paroxysmal 
cough  continues;  with  chicken-pox,  until  all  crusts 
have  fallen  off,  or  for  about  three  weeks  after  the 
eruption  appears ;  with  German  measles  for  one  week 
after  the  eruption  has  faded;  with  diphtheria,  at 
least  ten  days  after  the  throat  is  well  in  a  very  mild 
case,  and  four  weeks  if  the  case  has  been  severe; 
with  mumps  for  one  week  after  the  swelling  has  gone. 

What  should  he  done  when  a  child  shows  the  first 
symptoms  of  serious  illness? 

The  child  should  be  put  to  bed.  If  it  is  an  in- 
fant, the  food  should  be  diluted  to  one  half  the  usual 
strength;  if  an  older  child,  only  fluid  food  should 
be  given.  If  the  child  seems  feverish,  take  the  tem- 
perature.    If  the  bowels  are  constipated,  give  a  tea- 


178       THE  CARE  AND  FEEDING  OF  CHILDREN 

spoonful  of  castor  oil,  but  no  other  medicine  without 
the  doctor's  orders.  Send  for  the  doctor  at  once,  and 
until  he  comes  carefully  exclude  all  other  children 
from  the  room. 

By  what  nursery  training  may  the  examination 
and  treatment  of  sick  children  he  made  much  easier? 

By  teaching  all  children  to  gargle,  to  show  the 
throat,  to  take  pills,  and  by  constantly  teaching  them 
to  regard  the  doctor  as  the  child's  best  friend,  and 
his  visits  as  a  great  treat.  On  no  account  should  a 
child  be  frightened  into  obedience  by  threats  of  what 
the  doctor  will  do. 

With  care  and  patience  most  children  may  be 
taught  to  gargle  and  take  pills  at  four  or  five  years, 
and  to  show  the  throat  willingly  at  two  or  three.  All 
these  matters  should  be  made  a  part  of  the  child's 
education. 

SCUEVY 

What  is  scurvy  and  how  is  it  produced? 

Scurvy  is  a  disease  of  general  nutrition,  usually 
caused  by  the  long-continued  use  of  improper  food. 
Most  of  the  cases  come  from  the  use  of  the  prepared 
infant's  foods  sold  in  the  stores,  especially  when  they 
are  given  without  fresh  milk;  occasionally  the  use 
of  condensed  milk  and  of  sterilized  milk  is  followed 
by  scurvy ;  sometimes  it  is  seen  when,  owing  to  feeble 


SCURVY  179 


digestion,  it  has  been  necessary  to  make  cow's  milk 
very  weak  for  a  long  time. 

What  symptoms  are  seen  in  an  infant  with 
scurvy  ? 

At  first  there  is  only  indefinite  and  occasional 
soreness  in  the  legs  so  that  the  child  cries  out  when 
handled.  As  this  soreness  becomes  more  severe  the 
child  is  often  thought  to  have  rheumatism.  The 
gums  swell  and  are  of  a  deep  purple  colour.  There 
may  be  bleeding  from  the  gums,  nose,  bowels,  or 
black-and-blue  spots  may  be  seen  upon  the  legs.  The 
ankles  and  knees  may  swell.  The  child  grows  very 
pale,  loses  appetite  and  weight,  and  sleeps  badly. 

What  should  he  done  when  an  infant  shows  signs 
of  scurvy? 

The  diet  should  at  once  be  changed  to  fresh  milk, 
properly  modified  according  to  the  child's  digestion, 
but  not  sterilized  or  pasteurized.  The  juice  of  a 
sweet  orange  should  be  given,  best  about  an  hour  be- 
fore the  feeding.  At  first  one  or  two  teaspoonfuls, 
four  or  five  times  a  day;  later,  more  may  be  given 
if  the  symptoms  are  not  improved. 

Properly  treated  an  infant  with  scurvy  generally 
recovers  promptly  and  completely.  If  not  recog- 
nised, or  untreated,  it  may  cause  death. 

12 


180       THE  CARE  AND   FEEDING  OF  CHILDREN 


CONSTIPATION 

When  it  is  necessary  to  move  the  towels  imme* 
diately,  what  are  some  of  the  easiest  methods? 

An  injection  of  one  tablespoonful  of  sweet  oil 
may  be  given,  or  half  a  teaspoonful  of  glycerine  in 
one  tablespoonful  of  water,  or  a  teacupful  of  tepid 
soap  and  water,  or  a  glycerine  suppository.  Xone  of 
these  should  be  continued  excepting  under  the  physi- 
cian's directions. 

What  sort  of  a  syringe  is  to  he  'preferred  for  giv- 
ing an  injection  to  an  infant? 

The  bulb  syringe  is  the  simplest ;  this  consists  of 
an  oval  bulb  of  soft  rubber  and  a  soft  rubber  or  a 
hard  rubber  tip.    It  holds  one  or  two  ounces. 

What  is  the  most  essential  thing  in  preventing  or 
overcoming  constipation  ? 

The  formation  of  the  habit  of  having  the  bowels 
move  every  day  regularly  at  the  same  hour,  and 
proper  early  training  (see  page  154). 

What  is  the  test  hour? 

In  most  cases  immediately  after  the  first  meal 
in  the  morning. 

What  are  some  simple  means  hy  which  constipa- 
tion may  he  relieved? 

The  best  are  diet,  suppositories,  and  massage. 


CONSTIPATION  181 


The  changes  to  be  made  in  the  milk  of  consti- 
pated infants  have  been  mentioned  on  page  82.  The 
addition  to  the  milk  of  some  of  the  malted  foods, 
such  as  Mellin's  food  or  malted  milk,  is  sometimes 
useful.  For  little  children  the  fruit  juices  are  par- 
ticularly beneficial  when  given  half  an  hour  or  more 
before  the  first  morning  feeding,  with  half  a  glass 
of  water. 

For  older  children  the  amount  of  white  bread, 
toast,  and  potato,  should  be  reduced,  and  green  vege- 
tables, oatmeal,  and  Graham  bread  given,  with 
plenty  of  fruit  twice  a  day.  Raw  scraped  apples  are 
sometimes  of  more  value  than  any  other  fruit. 

The  best  suppositories  for  continuous  use  are 
probably  the  gluten  suppositories  of  the  Health 
Food  Company.  One  should  be  given  the  first 
thing  in  the  morning.  They  act  rather  slowly,  usu- 
ally in  about  two  hours.  In  obstinate  cases  one  may 
also  be  used  at  bedtime.  Glycerine  suppositories 
act  more  quickly,  but  are  too  irritating  for  regu- 
lar use. 

Massage  consists  in  rubbing  the  abdomen,  which 
may  be  done  in  one  of  two  ways:  Beginning  at  the 
right  groin,  the  hand  is  carried  up  to  the  ribs,  then 
across  to  the  opposite  side,  then  around  to  the  left 
groin.  The  abdomen  is  stroked  gently  at  first,  and 
afterward  deeper  pressure  used  as  the  child  becomes 


182       THE  CARE  AND  FEEDING  OF  CHILDREN 

accustomed  to  it.  The  second  method  is  by  rubbing 
the  deeper  parts  with  a  circular  movement — the  fin- 
gers not  moving  upon  the  skin — ^making  a  series  of 
small  circles,  beginning  at  the  right  groin  and  fol- 
lowing the  same  course  as  described  above.  Either 
method  should  be  employed  for  six  or  eight  minutes 
twice  a  day,  at  almost  any  regular  time,  except  soon 
after  a  meal. 

DIAEEHCEA 

In  case  a  child  is  taken  with  diarrhoea,  what 
should  he  done? 

\  With  a  moderate  looseness  of  the  bowels  in  an 
older  child,  solid  food  should  be  stopped,  and  boiled 
milk  given  diluted  with  gruel;  the  child  should  be 
kept  perfectly  quiet,  as  walking  about  always  aggra- 
vates such  a  disturbance.  If  the  symptoms  are  more 
severe  and  attended  by  fever  and  vomiting,  all  milk 
should  be  stopped  at  once,  and  only  broth,  barley 
water,  or  some  thin  gruel  given.  Some  cathartic, 
usually  castor  oil,  is  required  with  a  severe  attack. 

If  the  patient  is  an  infant,  the  milk  should  be 
diluted  and  especially  should  the  fat  be  reduced 
(see  page  76).  In  severe  attacks  with  vomiting  or 
frequent  foul  stools,  all. food  should  be  stopped  for  at 
least  twelve  hours  and  all  milk  for  a  longer  time,  and 
the  bowels  freely  moved  by  a  cathartic. 


BAD   HABITS  183 


Why  is  a  cathartic  necessary  if  the  movements 
are  already  frequent? 

Such  movements  are  nearly  always  due  to  an 
irritation  in  the  bowel,  set  up  by  the  fermenting 
food  which  has  not  been  digested.  The  diarrhoea 
is  Nature's  effort  to  get  rid  of  the  irritant.  Nothing 
to  stop  the  movements  should  be  given  until  the 
bowels  have  been  thoroughly  cleared  by  the  treat- 
ment mentioned. 

BAD    HABITS 

What  are  the  most  common  had  habits  of  young 
children? 

Sucking,  nail-biting,  dirt-eating,  bed-wetting, 
and  masturbation. 

What  do  children  such? 

Most  frequently  the  thumbs  or  fingers,  sometimes 
the  clothing  or  blanket;  often  the  "  pacifier  "  or  rub- 
ber nipple. 

When  is  this  habit  most  frequently  seen  ? 

It  begins  in  quite  early  infancy,  and  if  not 
broken  may  last  until  children  are  six  or  seven 
years  old. 

Is  the  sucTcing  habit  a  harmful  one? 
When  persisted  in  it  may  produce  a  misshapen 
mouth  or  fingers.     It  constantly  stimulates  the  flow 


184       THE  CARE  AND  FEEDING  OF  CHILDREN 

of  saliva  and  certainly  aggravates  disturbances  of 
digestion  during  which  the  sucking  habit  is  likely 
to  be  practised.  It  may  lead  to  thrush  or  other  forms 
of  infection  of  the  mouth.  It  is  not  necessary  as  a 
means  of  quieting  a  child,  though  it  may  in  some 
degree  cover  up  the  consequences  of  bad  feeding  or 
bad  training.  On  no  account  should  the  habit  of 
sucking  the  "  pacifier  "  be  allowed  as  a  means  of  put- 
ting children  to  sleep,  or  of  quieting  them  while  rest- 
less from  dentition  or  indigestion. 

How  is  the  sucking  habit  to  he  controlled? 

One  should  be  sure  in  the  first  place  that  the 
constant  sucking  of  fingers  is  not  due  to  hunger  from 
insufficient  food.  Sucking  of  the  hands  may  often 
be  controlled  by  wearing  mittens  or  fastening  the 
hands  to  the  sides  during  sleep.  In  more  obstinate 
cases  it  may  be  necessary  to  confine  the  elbow  by 
small  pasteboard  splints  to  prevent  the  child  from 
bending  the  arm  so  as  to  get  the  hand  to  the  mouth. 

When  are  nail-hiting  and  dirt-eating  seen,  and 
how  are  they  to  he  controlled? 

These  habits  belong  especially  to  children  over 
three  years  old.  They  are  seen  particularly  in  those 
who  are  excessively  nervous  or  whose  general  health 
is  below  par ;  sometimes  in  those  who  develop  serious 
nervous  diseases  later  in  life.     Children  with  such 


BAD  HABITS  185 


tendencies  should  be  closely  watched,  and  every 
means  used  to  break  up  these  habits  early.  Dirt- 
eating  is  a  morbid  craving  which  is  rarely  seen  in 
a  normal  child. 

At  what  age  may  a  child  generally  he  expected 
to  go  without  wetting  the  bed  during  the  night? 

Usually  at  two  and  a  half  years,  if  it  is  taken  up 
late  in  the  evening.  Some  children  acquire  control 
of  the  bladder  at  night  when  two  years  old,  and  a 
few  not  until  three  years.  After  three  years  habit- 
ual bed-wetting  is  abnormal. 

How  should  a  young"  child  addicted  to  hed-wet- 
ting  he  managed? 

At  three  or  four  years  of  age,  punishments  are 
sometimes  useful,  especially  when  it  seems  to  de- 
pend more  upon  the  child's  indifference  than  any- 
thing else.  They  are  of  no  value  in  older  children, 
rewards  being  much  more  efficacious.  In  all  cases 
one  should  give  a  child  plenty  of  milk  and  water 
early  in  the  day,  but  no  fluids  after  4  p.  m.,  the  sup- 
per being  always  of  solid  or  semi-solid  food.  The 
child  should  be  taken  up  regularly  at  ten  o'clock  or 
thereabouts.  It  often  happens  that  the  formation 
or  continuance  of  the  habit  is  due  to  the  child  being 
in  poor  general  condition,  to  some  irritation  in  the 
urine,  or  in  the  genital  organs.     Unless  the  simple 


186       THE  CARE  AND  FEEDING  OF   CHILDHEN 

means  mentioned  are  snccessfnl  the  child  should  be 
placed  under  the  charge  of  a  physician. 

What  is  masturbation? 

It  is  the  habit  of  rubbing  the  genital  organs  with 
the  hands,  with  the  clothing,  against  the  bed,  or  rub- 
bing the  thighs  together.  Sometimes  the  child  sits 
upon  the  floor,  crosses  its  thighs  tightly  and  rocks 
backward  and  forward.  Many  of  these  things  are 
passed  over  lightly  and  are  regarded  for  months  as 
simply  a  "  queer  trick "  of  the  child.  It  may  be 
seen  at  any  age,  even  in  those  not  more  than  a  year 
old,  and  in  both  sexes. 

How  should  such  a  child  he  treated? 

Masturbation  is  the  most  injurious  of  all  the  bad 
habits,  and  should  be  broken  up  just  as  early  as  pos- 
sible. Children  should  especially  be  watched  at  the 
time  of  going  to  sleep  and  on  first  waking.  Punish- 
ments and  mechanical  restraint  are  of  little  avail  ex- 
cept with  infants.  With  older  children  they  usually 
make  matters  worse.  Rewards  are  much  more  effi- 
cacious. It  is  of  the  utmost  importance  to  watch  the 
child  closely,  to  keep  his  confidence,  and  by  all  pos- 
sible means  to  teach  self-control. 

Some  local  cause  of  irritation  is  often  present, 
which  can  be  removed.  Medical  advice  should  at 
once  be  sought. 


VACCINATION  187 


VACCI]SrATIO]S" 

Nowadays  when  small-pox  occurs  so  seldom  is  it 
necessary  to  have  every  child  vaccinated? 

It  should  by  all  means  be  done.  It  is  only  by 
the  practice  of  general  vaccination  that  small-pox  is 
kept  down.  In  countries  or  in  communities  where 
vaccination  is  neglected,  frightful  outbreaks  of  small- 
pox occur  every  now  and  then  just  as  in  olden  times. 

What  is  the  best  time  for  vaccination? 

The  time  usually  selected  is  from  the  third  to  the 
sixth  month.  It  may  be  deferred  in  a  very  delicate 
child  who  is  not  likely  to  be  exposed  to  small-pox,  or 
in  a  child  suffering  from  any  form  of  skin  disease. 

Which  is  preferable  for  vaccination,  the  arm  or 
the  leg? 

The  part  which  can  be  most  easily  protected  and 
kept  at  rest  is  to  be  chosen.  In  infants  who  do  not 
yet  walk  or  creep,  the  leg  is  to  be  preferred ;  in  older 
children,  in  most  circumstances,  the  arm.  If  older 
children  are  vaccinated  on  the  leg,  they  should  not 
be  allowed  to  walk  much  while  the  vaccination  is 
active. 

When  should  vaccination  be  repeated? 
An  unsuccessful  vaccination  proves  nothing  and 
should  be  repeated  in  two  or  three  weeks.    If  success- 


188       THE  CARE  AND   FEEDING  OF  CHILDREN 

fully  vaccinated  in  infancy,  a  child  should  invariably 
be  revaccinated  before  puberty.  If  exposed  or  likely 
to  be  exposed  to  small-pox  at  any  time  vaccination 
should  be  repeated. 


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INDEX 


Airing,  27. 
Albumin  water,  148. 
Appetite,  loss  of,  86. 

Barley  water  and  barley  jelly, 

147. 
Baths,  15-16. 
bran,  19. 
cold  sponge,  30. 
salt,  20. 
Bed-wetting,  185. 
Beef,  scraped,  146. 
Beef  juice,  preparation  of,  144. 

use  of,  83. 
Bowel  movements,  153-155. 
Bread,    crackers,    and    cakes, 

133. 
Broth,  mutton,  chicken,  veal, 
beef,     preparation     of, 
145,  146. 
Broths  and  soups,  uses  of,  132. 

Cereals,  for  infants,  75. 

for  older  children,  131. 
Chest,  table,  35. 
Chicken-pox,  175.' 


Circumcision,  17. 
Clothing,  21-23. 
Colds,  prevention  of,  30, 
Colic,  changes  in  food  for,  90, 
93. 

in  breast-fed  infants,  49. 

symptoms  and  treatment  of, 
170. 
Condensed  milk,  93. 
Constipation,  diet  for,  91. 

general  treatment  of,  180. 

in  breast-fed  infants,  49. 
Convulsions,  168. 
Cream,  for  older  children,  126. 

how  obtained,  65. 
Croup,  172. 
Cry,  160. 

Dentition,  36-38. 
Desserts,  133. 
Development,  30-36. 
Diarrhoea,  changes  in  food  for, 
96. 
general  treatment  of,  182. 
Diet  (see  Feeding). 
Diphtheria,  175. 
191 


193       THE  CARE  AND  FEEDING  OF  CHILDREN 


Earache,  171. 
Eggs,  127,  149. 

for  infants,  83. 
Exercise,  159, 
Eyes,  17,  18. 

Feeding,  of  infants,  42-121. 
artificial,  54-121. 

modification    of    cow's 
milk  in,  59-76. 
formulas  from  7  per 

cent,  milk,  67-73. 
formulas  from  whole 
milk,  73-76. 
nursing,  42-54.* 
of  older  children,  125-144. 
Fever,  163-165. 
Fish,  128. 

Fontanel,  closed,  33. 
Foods,  proprietary,  95. 
Foreign  bodies,  in  the  ear,  170. 
in  the  nose,  170. 
swallowed,  169. 
Foreskin,  17. 
Fruits,  117,  119,  135. 

Genital  organs,  16,  17. 
German  measles,  174. 
Granum,  Imperial,  148. 
Gruels,  preparation  of,  147. 
uses  of,  82. 

Head,  measurements  of,  table 
of,  35. 
supported,  33. 
Height,  table  of,  35. 


Indigestion,  in  infants,  96. 
in  older  children,  137-141. 

Junket,  146. 

Kissing,  168. 

Lime  water,  148. 
Lifting  children,  162. 

Masturbation,  186. 

Measles,  173. 

Meat,  128. 

Menstruation,     effect     of,    on 

breast  milk,  45. 
Milk,    cow's,    modification    of, 
59-76. 
selection  and  care  of,  54. 
top,  63-65. 
mother's,  41-^2.    , 
Modification  of  cow's  milk  (see 

Feeding),  59-76". 
Mouth,  18. 
Mumps,  176. 

Napkins,  24. 

Nervousness,  165. 

Nipples,  100. 

Nursery,  25. 

Nursing  (breast  feeding),  43. 

diet  during,  44. 

indigestion  during,  47,  49. 

intervals,  43. 

when  not  attempted,  42,  48. 
Nursing  bottles,  100. 


IXDEX 


193 


Oat  water  and  gruel,  147,  148. 
Orange  juice,  83. 
Overfeeding,  84. 

"Pacifier,"  184. 
Pasteurized  milk,  110. 
Peptonized  milk,  112. 
Prickly  heat,  20. 

Refrigerators  for  nursery,  58. 
Rice  water  and  gruel,  147. 

Scarlet  fever,  174. 

Scurvy,  178. 

Seven  per  cent,  milk,  formulas 

from,  68,  75. 
Skin,  19. 
Sleep,  155-159. 
Speech,  34. 
Sprue,  18. 

Sterilized  milk,  107. 
Stomach  indigestion,   changes 

in  food  in,  96. 
Stools,  153-155. 


Sugars,  in  infant  feeding,  61. 
for  older  children,  134. 

Teeth,  36-38. 
Temperature,  163-165. 
Top-milk,  63-65. 
Toys,  166. 

Vaccination,  187. 
Vegetables,  129. 
Vomiting,  88. 

in  breast-fed  infants,  48. 

Walking  alone,  34. 
Water,  for  infants,  92. 

for  older  children,  120. 
Weaning,  49-54. 

from  bottle,  117. 
Weight,  30,  31. 

chart,  189,  190. 

table  of,  35,  36. 
Whey,  146. 
Whole    milk,    formulas    from, 

73-76. 
Whooping-cough,  175. 


(36) 


THE    END 


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